Rates Of Gestational Diabetes Mellitus Research Articles

Assessment of the optimal cutoff value of fasting plasma glucose to establish diagnosis of gestational diabetes mellitus in Chinese women

Our aim is to assess the optimal cutoff value of fasting plasma glucose (FPG) in Chinese women at 24–28 weeks’ gestation by performing oral glucose tolerance test (OGTT) to improve diagnostic rate of gestational diabetes mellitus (GDM). Data were derived from the Medical Birth Registry of Xiamen. A FPG cutoff value of 5.1 mmol/L confirmed the diagnosis of GDM in 4,794 (6.10%) pregnant women. However, a FPG cutoff value of 4.5 mmol/L should rule out the diagnosis of GDM in 35,932 (45.73%) pregnant women. If we use this cutoff value, the diagnosis of GDM to about 27.3% of pregnant women will be missed. Additionally, a 75-g OGTT was performed in pregnant women with FPG values between 4.5 and 5.1 mmol/L, avoiding the performance of formal 75-g OGTT in about 50.37% pregnant women. Meanwhile, according to maternal age and pre-pregnancy BMI categories, with FPG values between 4.5 mmol/L and 5.1 mmol/L, which had high sensitivity, to improve the diagnostic rate of GDM in all groups. Further researches are needed to present stronger evidences for the screening value of FPG in establishing the diagnosis of GDM in pregnant women.

Screening for gestational diabetes mellitus – Can we use the 50-g glucose challenge test of the previous pregnancy?

AimTo assess the association between previous pregnancy glucose challenge test (GCT) result among non-diabetic women and the rate for gestational diabetes mellitus (GDM) in the subsequentpregnancy. MethodsRetrospective database study in a university affiliated medical center from 2005 to 2017. Women who had a singleton pregnancy and two consecutive deliveries in our medical center were included. GDM diagnosis was based on either National Diabetes Data Group or Carpenter and Coustan criteria. Univariate analysis was followed by multivariate logistic regression. ResultsA total of 31,861 women were included. GDM incidence among the subsequent pregnancies was 2.1% (670 women). Parturients with GDM had higher mean GCT results in their previous pregnancy compared with parturients without GDM (127.5 ± 28 VS. 98.7 ± 24 mg/dl, p < 0.001). Women with GDMA2 had higher former GCT results than women with GDMA1 (135.9 ± 28 VS. 125.7 ± 27 mg/dl, p < 0.001). Positive association between GCT results in previous pregnancy and rates of GDM in the subsequent pregnancy was noted. Using a GCT value of 107 mg/dl (65th percentile), the area under the receiver-operating curve was 0.79. ConclusionGCT results in previous pregnancy is associated with GDM incidence in the subsequent pregnancy. Future prospective studies are warranted to better delineate the best screening approach for this subset of patients.

Incidence and Outcomes of Gestational Diabetes Mellitus Using the New International Association of Diabetes in Pregnancy Study Group Criteria in Hôpital Maisonneuve-Rosemont.

At 1 Canadian university hospital, pregnant women were routinely screened for gestational diabetes mellitus (GDM) with a 75-g oral glucose tolerance test (OGTT). Diagnostic plasma glucose thresholds were as follows: fasting: ≥5.3 mmol/L, 1 h: ≥10.6 mmol/L and 2 h: ≥9.0 mmol/L. In 2015, diagnostic thresholds were reduced to those recommended by the International Association of Diabetes in Pregnancy Study Group (IADPSG) as follows: fasting: ≥5.1 mmol/L, 1 h: ≥10.0 mmol/L and 2 h: ≥8.5 mmol/L. However, subsequent Diabetes Canada guidelines state that further evidence is required before recommending those thresholds. Our objectives were to compare pregnancy outcomes of all pregnant women who underwent a 75-g OGTT before and after the adoption of the IADPSG criteria. Pregnancy outcomes of all women (N=2,830) that had a pregnancy OGTT at the Hôpital Maisonneuve-Rosemont between July 1, 2014 and March 1, 2015 (pre-IADPSG group) were compared with women who were screened between March 1, 2015 and January 1, 2016 (post-IADPSG group). Medical files were reviewed to compare outcomes. Women in the post-IADPSG group had a higher early body mass index (26.3 vs 25.5 kg/m2, p=0.01) and more chronic hypertension (3.7% vs 1.2%, p<0.0001), respectively. OGTT results were similar, but rates of GDM were 10.8% (141 of 1,295) in the pre-IADPSG group and 17.6% (271 of 1,535) in the post-IADPSG group. In the post-IADPSG group, pre-eclampsia rates were lower (1.0% vs 2.2%, p=0.021), as was labour induction (25.6% vs 32.8%, p<0.0001) and neonatal intensive care unit admission (4.8% vs 8.5%, p<0.001), respectively. Adopting IADPSG criteria for GDM improved pregnancy outcomes in our obstetric population.

Confounding effect of ethnic diversity on booking-in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997-2016.

Maternal obesity is a key risk factor for morbidity in pregnancy. Accurate data on trends in obesity are required in high-risk populations such as in western Sydney to implement effective policy. This study examines multi-site public hospital data on maternal ethnicity, body mass index (BMI), gestational diabetes mellitus (GDM) and hypertension across 20years in Western Sydney Local Health District (WSLHD). This is a retrospective cohort study of all women who delivered a live birth beyond 20weeks at Westmead, Blacktown and Auburn Hospitals (WSLHD) between 1 January 1997 and 31 December 2016. There were 112308 pregnant women included. Between 1997 and 2006, mean booking-in BMI climbed from 24.9 (median 23.9) to peak at 26.2 (24.9). It then fell to 25.3 (24.1) in 2012 before rising to 25.6 (24.4) in 2016. Rates of hypertensive disorders changed little over the period, with a small fall in pre-eclampsia. In contrast, there was a progressive upward trend in the prevalence of GDM, accelerating considerably after 2010. These trends were associated with a shifting ethnic profile with proportions of Australia/New Zealand-born women falling from 56.9% to 36.8%, while those from South Asia increased from 4.5% to 26.3%. Western Sydney booking-in BMI fluctuated between 1997 and 2016, reaching its peak in 2006. Despite this, rates of GDM progressively rose, with one in six mothers in western Sydney now diagnosed with some form of the condition. Both patterns are associated with a notable shift in the ethnic profile of patients booking-in to antenatal care in the region.

Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What's Missing? A Qualitative Study.

Gestational diabetes mellitus (GDM) increases the risk of pregnancy complications. South Asian immigrant women have among the highest rates of GDM in Canada and they also have the highest lifelong risk of developing type 2 diabetes after a GDM pregnancy. Diabetes Canada has been developing diabetes education material that accounts for the cultural preferences of South Asians. However, there is uncertainty to whether South Asian immigrants are aware of these resources or trust them, or if other factors influence their uptake of advice. In this study, we conducted qualitative interviews to explore, among South Asian immigrant women with GDM: 1) their awareness of diabetes education resources, 2) their attitudes toward information from different resources and varying health-care providers and 3) their barriers and facilitators for GDM management recommendations. Gender theory is embedded in this study, as culturally specific gender roles regarding motherhood have been shown to be important to South Asian immigrant women and their perceptions of health. There was an emergence of 3 main themes. First, awareness of culturally tailored educational resources is low. Second, there is an overabundance of GDM management information, which leads to variability among participants of how they rank accuracy of informational sources. Finally, there is a gender role reversal present, where women are being taken care of by their families instead of being the providers of care. These results indicate that better dissemination strategies for GDM educational material are needed for health-care providers and patients, and may require additional consideration of family involvement during GDM education sessions.

Inositol Supplementation in the Prevention of Gestational Diabetes Mellitus.

Inositol, an emerging novel therapy for the treatment of gestational diabetes mellitus (GDM), is a cyclic polyol that has insulin-like effects and plays an important role in glucose homeostasis. The conventional treatment of GDM with insulin and oral antihyperglycemic drugs usually comes with side effects, paving the way for and shedding spotlight on clinical trials involving inositol. This review analyzed a host of recent trials that involved inositol supplementation for preventing GDM and their positive outcomes in reducing the rate of GDM among obese and overweight pregnant women, as well as women with polycystic ovarian syndrome (PCOS) or a family history of type 2 diabetes mellitus.

Complications of pregnancy in morbidly obese patients: What is the impact of gestational diabetes mellitus?

ObjectivesThe synergistic role of severe obesity and gestational diabetes mellitus (GDM) on pregnancy complications has been poorly studied. We aim to analyze the impact of GDM on pregnancy complications in women with class III obesity. Material and methodswe performed a retrospective monocentric study including women with a pregestational BMI≥40kg/m2 with a singleton pregnancy from January 1996 to December 2014. We compared the risks of maternal, fetal and neonatal complications between patients with GDM and those without GDM. ResultsWe included 354 patients, 121 (34.3%) had GDM and 63 needed insulin treatment (52.9% of the GDM women). Patients with GDM were older (30.4±5.1 vs 28.9±4.8 years,p=0.008) and had more frequently a history of GDM (24.8% vs 6.1%; p<0.0001). Patients with GDM were more often hospitalized (47.8% vs 29.8%, p=0.001) and were more likely to have premature birth (11.7% vs. 5.3%, p=0.031). Neonates from mothers with GDM were more frequently large for gestational age (31.6% vs 19.4%, p=0.011), and had a higher rate of transfers to neonatal intensive unit (9.2% vs 4.0%, p=0.047). There was no difference for preeclampsia, C-section, shoulder dystocia, neonatal hypoglycemia or postpartum complications. Outcomes were comparable in women with or without insulin therapy. ConclusionThe rate of GDM is particularly high in class III obese women. Morbidly obese women with GDM were more at risk for complications and needed more often insulin therapy. Our results suggest to pay a particular attention in this high-risk population.

Correlation of viral load of Hepatitis B with the gestation period and the development of diabetes mellitus.

ObjectiveTo elaborate how the viral load of HBV affects the gestational diabetes mellitus (GDM).MethodsWe enrolled 196 chronic HBV-infected pregnant patients in this hospital between January 2012 and December 2017 for delivery in this study. According to the viral load of HBV-DNA, these patients were divided into the HBV-DNA negative group (n = 107, <1 × 103 copies/mL) and HBV-DNA positive group (n = 89, ≥1 × 103 copies/mL). Simultaneously, 100 HBV-free pregnant women who were admitted to the hospital for delivery were included in the control group. Before delivery, fasting venous blood was drawn from the pregnant women to perform the HBV-DNA quantification through qRT-PCR; from the 24th to 28th gestation week, all pregnant women underwent OGTT, with the third-trimester-of-pregnancy as the endpoint. Besides, we also measured the FBG, 2hPG and hemoglobin A1c (HbAIc).ResultsAmong 168 pregnant patients carrying chronic HBV, viral load of 107 patients was less than 1 × 103 copies/mL (54.6%), and 89 not less than 1 × 103 copies/mL (45.4%). The incidence rates of GDM in the HBV-DNA negative group and HBV-DNA positive group were 18.7% and 19.1%, respectively, significantly higher than that in the control group (p < 0.05), while the difference of the incidence rates of GDM between two HBV-DNA groups were not significant (p > 0.05). In HBV-DNA negative group and HBV-DNA positive group, FBGs, 2hPGs and HbAIcs were respectively (6.96 ± 0.36) mmol/L and (7.04 ± 0.37) mmol/L, (10.26 ± 1.29) mmol/L and (10.16 ± 1.12) mmol/L, and (8.66 ± 0.97) % and (8.91 ± 0.90) %, significantly higher than (4.57 ± 0.34) mmol/L, (6.16 ± 0.86) mmol/L and (5.13 ± 0.57) % (p < 0.05); however, between two HBV-DNA groups, comparisons of the FBG, 2hPG and HbAIc suggested no significant differences (p > 0.05). In 196 patients carrying chronic HBV, positive correlations were identified between the viral load of HBV-DNA, and FBG, 2hPG and HbAIc (p < 0.01).ConclusionHBV infection can increase the incidence rate of GDM, and the viral load of HBV-DNA is correlated with the glucose level of pregnant patients.

194-LB: Effectiveness of Following Mediterranean Diet (MedDiet) Recommendations in the Real World in the Incidence of Gestational Diabetes Mellitus (GDM) and Adverse Maternal-Fetal Outcomes: A Prospective, Universal Interventional Study

Background: We previously reported that a MedDiet, supplemented with extra-virgin olive oil (EVOO) and pistachios, reduces GDM incidence (WHO criteria) and several adverse outcomes. To assess effects in the in the real world we evaluated the adoption of a MedDiet starting at the 1st gestational visit on the rate of GDM (compared with the control group/CG and intervention group/IG from the previous trial). We also compared the rate of adverse perinatal outcomes between women with and without GDM. Research Design and Methods: This is a prospective, clinic-based, interventional study with a single group. All normoglycemic women attending their 1st gestational visit &amp;lt;12 gestational weeks (GW) between November 2016-2017 were invited to participate; 1066 signed an informed consent. Women received lifestyle guidance with emphasis on consuming EVOO and nuts daily. 932 women were analyzed. Binary regression analyses were performed to assess the risk of pregnancy-induced hypertension, preeclampsia, gestational weight gain (GWG), C-section, perineal trauma, preterm delivery, small/large-gestational-age new-borns and admissions in neonatal ICU and observation. Results: GDM rate was of 13.9%; this was significantly lower than the CG: RR 0.81 (0.73-9.28),p&amp;lt;0.001 and no different to the IG:RR 0.96 (0.85-1.07),p=0.468. GWG (kg) was lower in GDM women (10.88±6.46 vs. 12.30±5.42; p=0.013). Excessive weight gain was also lower (RR 0.91 (0.86-0.96)) without a significant increase of insufficient weight gain. We found no differences in any perinatal adverse outcomes. Conclusion: This study translates evidence to clinical practice, providing a universal and easy-to-apply approach to reduce GDM. An early nutritional intervention before GDM diagnosis ameliorates differences in maternofoetal adverse outcomes between GDM and no-GDM women. Disclosure A. Duran: None. N. Garcia de la Torre: None. C. Assaf-Balut: None. L. Del Valle: None. J. Ines: None. J. Valerio Deogracia: None. E. Bordiu: None. M. Fuentes: None. A. Barabash: None. M. Cuesta: None. M.A. Rubio: None. A.L. Calle: None. Funding Instituto de Salud Carlos III of Spain; Fondo Europeo de Desarrollo Regional; Sociedad de Endocrinolog?a Nutrici?n y Diabetes de la Comunidad de Madrid (IPI/2017/NR2)

The association between gestational diabetes mellitus, antipsychotics and severe mental illness in pregnancy: A multicentre study.

There have been conflicting findings for severe mental illnesses and the risk for gestational diabetes mellitus (GDM). Outside of pregnancy, both severe mental illnesses and specific antipsychotic medications have been associated with an elevated risk for metabolic disorders, including type2 diabetes mellitus. This study examined the risk of developing GDM in relation to mental disorder, psychotropic treatment and comorbid risk factors. A retrospective study of 539 pregnant women with mental disorders was carried out. Measures included GDM diagnosis, mental health diagnosis, psychotropic medication, body mass index, age, smoking, alcohol and illicit substance use. This study found that women with psychotic disorders had a significantly elevated risk for GDM (20.9%) compared with women with non-psychotic severe mental illnesses during pregnancy (P=0.023), and nearly threefold the expected population rate (8.3%). Furthermore, women using specific antipsychotic agents - risperidone (P=0.016), clozapine (P<0.001) and higher-dose quetiapine (P=0.029) - also had a higher risk of developing GDM. After adjusting for maternal age and body mass index, women taking these specific agents continued to have a fourfold risk of having GDM compared with women not taking these agents. Smoking, alcohol consumption and illicit drug use were not associated with elevated GDM rate in women with mental disorders. These findings support the need for early screening and closer surveillance of metabolic risk in pregnancy for women with psychotic disorders and those taking specific atypical antipsychotic agents.

17α-Hydroxyprogesterone Caproate and the Risk of Glucose Intolerance in Pregnancy

To evaluate whether 17α-hydroxyprogesterone caproate use in preventing preterm birth increases the risk of gestational diabetes mellitus (GDM). Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before October 2018. Keywords included "gestational diabetes," "preterm birth," "pregnancy," and "17-hydroxyprogesterone caproate." Studies comparing 17α-hydroxyprogesterone caproate with unexposed control groups in women with singleton gestation and a history of a prior spontaneous preterm birth were included. The primary outcome was the development of GDM. Secondary outcomes included abnormal 1-hour, 50-g glucose screen results and mean venous blood glucose levels. Summary estimates were reported as mean differences and 95% CI for continuous variables or relative risk (RR) with 95% CI for dichotomous outcomes. Meta-analysis was performed using the random effects model of DerSimonian and Laird. Six studies, four of which were cohort studies, met inclusion criteria and were included in the final meta-analysis. Of the 5,053 women, 1,538 (30.4%) received 17α-hydroxyprogesterone caproate and 3,515 (69.6%) were in unexposed control groups. The overall rate of GDM in women exposed to 17α-hydroxyprogesterone caproate was 10.9% vs 6.1% in women who were not exposed (RR 1.77, 95% CI 1.22-2.55). After exclusion of the cohort studies, the summary estimate of effect was nonsignificant among women who had been randomly allocated to 17α-hydroxyprogesterone caproate (RR 1.21, 95% CI 0.63-2.36). Women with singleton gestations receiving weekly 17α-hydroxyprogesterone caproate for recurrent preterm birth prevention had a significantly higher incidence of abnormal glucose test results and GDM compared with those in unexposed control groups, a finding that did not hold among women who had been randomly allocated to 17α-hydroxyprogesterone caproate. PROSPERO, CRD42016041694.

Antipsychotic Use During Pregnancy and the Risk of Gestational Diabetes Mellitus: A Systematic Review.

This study aimed to review the current literature examining a potential relationship between the use of antipsychotic drugs during pregnancy and gestational diabetes mellitus (GDM). PubMed was searched for English language reports between January 1, 1996, and March 31, 2018, by using combinations of the following key words: antipsychotics, pregnancy, FGAs, SGAs, GDM, obstetric outcomes, pregnancy outcomes, obstetric complications, maternal complications, clozapine, olanzapine, risperidone, aripiprazole, amisulpirde, ziprasidone, quetiapine, haloperidol, chlorpromazine, zuclopenthixol, and flupenthixol. Studies but not case reports, case series, or reviews published in a peer-reviewed journal were eligible for inclusion. A total of 10 relevant studies that met the review criteria were examined. Data from these studies indicated that the prevalence rates of GDM in pregnant women using antipsychotic drugs and the nomedication group were 2.6% to 22% and 0.95% to 10.7%, respectively. Most comparative studies reported that antipsychotic treatment during pregnancy was not significantly associated with increased in risk of GDM. In addition, the study results also suggested that underlying maternal psychopathologies might affect the risk of GDM. Findings from some studies suggesting a higher risk of GDM in pregnant women who were administered antipsychotic drugs were not confirmed by results of many other studies. The current evidence suggests no significant relationship between antipsychotic drugs, including second- and first-generation antipsychotics, and the risk of GDM.

Influence of different diagnostic criteria on gestational diabetes mellitus incidence and medical expenditures in China.

Aims/IntroductionTo summarize the development of the criteria for diagnosing gestational diabetes mellitus (GDM) in China, and investigate how different GDM diagnostic criteria influence the national prevalence of GDM, the national health system and the economic burden of GDM in China.Materials and MethodsRetrospectively using data from women undergoing a 2‐h, 75‐g oral glucose tolerance test at 24–28 gestational weeks in the First Affiliated Hospital of Jinan University (Guangzhou, Guangdong, China) from January 2011 to December 2017, the prevalence rate of GDM and its impacts on the national health system were evaluated using different criteria (the 7th edition textbook criteria, National Diabetes Data Group 1979, World Health Organization 1985, European Association for the Study of Diabetes 1996, Japan 2002, American Diabetes Association [ADA] 2011 [International Association of the Diabetes and Pregnancy Study Groups], and National Institute for Heath and Care Excellence 2015).ResultsThe incidence rates of GDM based on the ADA 2011 and National Institute for Heath and Care Excellence 2015 were, respectively, 22.94% (P < 0.01) and 21.72% (P < 0.01), over threefold higher than implementing the 7th edition textbook criteria (P < 0.001). On the contrary, the incidence rates of GDM diagnosed with the National Diabetes Data Group 1979 and World Health Organization 1985 guidelines were significantly less than the 7th edition textbook criteria (P < 0.001). From 2001 to 2016, the estimated national cost of treating GDM rose from ¥3.9 billion to ¥27.4 billion after implementing the ADA 2011 guidelines.ConclusionsWith the implementation of ADA 2011 (International Association of the Diabetes and Pregnancy Study Groups) guidelines, there are fewer adverse perinatal outcomes and cases of type 2 diabetes mellitus in the long term, but the medical costs increased significantly, and the cost‐effectiveness of diagnostic criteria in China is still yet to be confirmed.

403: Screening for GDM– can we use the results of the GCT of the previous pregnancy?

To assess whether previous pregnancy glucose challenge test (GCT) result among non-diabetic women may serve in an index pregnancy. as a screening tool for Gestational Diabetes Mellitus (GDM) Retrospective study based on computerized records in a single large university medical center. All women who had a singleton pregnancy and two subsequent deliveries in our medical center between 2005 and 2017 were included. Women with Diabetes Mellitus or GDM in the previous pregnancy and women without documented GCT results in their previous pregnancy, were excluded. GDM diagnosis is based on either National Diabetes Data Group criteria or the Carpenter and Coustan criteria. Unpaired student T-test and one way ANOVA were used to asses associations between GCT levels and maternal characteristics. Multivariable logistic model was conducted to assess the independent role of GCT level at previous pregnancy on GDM at index pregnancy. ROC curves were constructed. All tests are two-sided. P value below 0.05 was considered statistically significant. Analyses were carried out using SPSS software package version 22 (IBM, Armonk, NY). A total of 31,861 women met inclusion criteria. Of those, 670 (2.1%) had GDM in the index pregnancy. Parturients with GDM in the index pregnancy had higher mean levels of GCT in the previous pregnancy in comparison to parturients without GDM (127.5±28 VS. 98.7±24 mg/dl, respectively, p<0.001). There was a positive association between GCT results in previous pregnancy and rates of GDM in index pregnancy (Figure). Multivariate analysis controlling for known risk factors for GDM revealed that GCT levels in previous pregnancy were independently associated with rates of GDM in index pregnancy (1.04, 95% CI 1.03-1.04, p<0.001). Using a GCT value of 107 mg/dl (65th percentile), the area under the ROC curve was 0.79, suggesting a fair to good accuracy of GCT results in previous pregnancy in predicting GDM in index pregnancy. In addition, the NPV of this value is very high, only 7 of 1000 women with this results or lower will have GDM in the index pregnancy (Table). GCT result in previous pregnancy may serve as a screening tool for GDM in an index pregnancy. Parturients with low levels of GCT may not need repeat screening for GDM in the index pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Geospatial Analysis of Birth Records to Target Programming for Mothers With Gestational Diabetes Mellitus in Michigan, 2013.

The incidence of gestational diabetes mellitus (GDM) in the United States has increased during the past several decades. The objective of this study was to use birth records and a combination of statistical and geographic information system (GIS) analyses to evaluate GDM rates among subgroups of pregnant women in Michigan. We obtained data on maternal demographic and health-related characteristics and regions of residence from 2013 Michigan birth records. We geocoded (ie, matched to maternal residence) the birth data, calculated proportions of births to women with GDM, and used logistic regression models to determine predictors of GDM. We calculated odds ratios (ORs) from the exponentiated beta statistic of the logistic regression test. We also used kernel density estimations and local indicators of spatial association (LISA) analyses to determine GDM rates in regions in the state and identify GDM hot spots (ie, areas with a high GDM rate surrounded by areas with a high GDM rate). We successfully geocoded 104 419 of 109 168 (95.6%) births in Michigan in 2013. Of the geocoded births, 5185 (5.0%) were to mothers diagnosed with GDM. LISA maps showed a hot spot of 8 adjacent counties with high GDM rates in southwest Michigan. Of 11 064 births in the Southwest region, 829 (7.5%) were to mothers diagnosed with GDM, the highest rate in the state and a result confirmed by geospatial analyses. Birth data and GIS analyses may be used to measure statewide pregnancy-associated disease risk and identify populations and geographic regions in need of targeted public health and maternal-child health interventions.

Gestational Diabetes and Maternal Weight Management During and After Pregnancy

Background: Women diagnosed with gestational diabetes mellitus (GDM) substantially modify their diets during pregnancy to control hyperglycemia. These changes could also affect maternal weight management. Materials and Methods: From July 2014 to December 2015 we enrolled women with and without GDM in a prospective cohort study to compare their mean rates of (1) weight gain before GDM screening, (2) weight gain after GDM screening, and (3) postpartum weight loss. All GDM-affected women were referred to Medical Nutrition Therapy and asked to self-monitor blood glucose until delivery. Rate comparisons were conducted separately for each interval using weighted t-tests and inverse probability of treatment weighting (IPTW) to account for age and prepregnancy body mass index (BMI). Linear regression models were developed to characterize the association of GDM status and rate of weight change. Results: The study included 40 women with GDM and 49 women without GDM. The IPTW analysis found that (1) women with and without GDM had similar mean rates of gestational weight gain before GDM screening (0.41 ± 0.26 kg/week vs. 0.45 ± 0.35 kg/week, respectively, p = 0.86), (2) women with GDM gained weight at a significantly lower mean rate than women without GDM following GDM screening (0.30 ± 0.28 kg/week vs. 0.53 ± 0.28 kg/week, respectively, p = 0.001), and (3) women with and without GDM had similar mean rates of postpartum weight loss (-1.37 ± 0.58 kg/week vs. -1.28 ± 0.46 kg/week, respectively, p = 0.73). The linear regression model (adjusted for age and prepregnancy BMI) demonstrated that women with GDM gained 0.19 kg/week less than women without GDM (p = 0.004) during pregnancy after GDM screening. Conclusions: In the postpartum period, women with GDM lose weight at similar rates to women without GDM despite gaining weight at significantly lower rates following GDM screening. Diagnosis and treatment of GDM may improve maternal weight management, but this benefit is limited to late pregnancy.

Comparing Different Diagnostic Guidelines for Gestational Diabetes Mellitus in Relation to Birthweight in Sri Lankan Women.

Introduction: While the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is widely adopted in many countries, clinicians have questioned the applicability of these diagnostic thresholds for different races/ethnicities. We first compared the prevalence of gestational diabetes mellitus (GDM) diagnosed with different criteria including IADPSG, World Health Organization (WHO) 1999 and Sri Lankan national guidelines, and subsequently related individual guidelines-specific GDM prevalence to offspring birthweight in Sri Lanka.Materials and Methods: We retrospectively collected data on singleton pregnancies (n = 795) from two tertiary hospitals in Sri Lanka. We applied three diagnostic guidelines to define GDM, namely IADPSG criteria, the Sri Lankan national and WHO 1999 guidelines. We calculated the age- and first booking BMI-adjusted prevalence rates of GDM and assessed the association of GDM (using each guideline) with birthweight.Results: The age- and first booking BMI-adjusted GDM prevalence rates were 31.2, 28.0, and 13.1% for IADPSG criteria, Sri Lankan national and WHO 1999 guidelines, respectively. The IADPSG criteria identified 90 distinctive GDM cases at a lower cut-off of fasting glucose (from 5.1 to 5.5 mmol/L) while Sri Lankan national guideline identified 15 distinctive GDM cases at a lower cut-off for 2-h glucose (from 7.8 to 8.4 mmol/L). After adjusting for age, GDM diagnosed by IADPSG criteria was associated with higher birthweight [90.8 g, 95% CI: 10.8, 170.9], while the associations for GDM diagnosed either by Sri Lankan national or WHO 1999 guidelines were not significant.Conclusion: Adopting the IADPSG criteria for diagnosing GDM may be important in Sri Lankan pregnant population.

Free Thyroxine in Early Pregnancy and Risk of Developing Gestational Diabetes

Background: Pregnancy has a considerable physiological impact on the thyroid gland and its metabolic unction and to meet the increased demands during pregnancy. Thyroid disease is known to impact pregnancy outcomes, and gestational diabetes is the most common obstetric metabolic disease. Both of these conditions can cause short- and long-term harm to the mother and child, and an increasing number of scholars have therefore begun to investigate whether there is a correlation between thyroid disease and GDM Objective: evaluation of the relations between different thyroid hormone levels in early pregnancy and the incidence of gestational diabetes mellitus (GDM). Study design: This prospective observational cross-sectional study was conducted during the January 2018 to June 2018. The study comprised one hundred, euthyroid women with singleton pregnancy who provided early pregnancy serum samples for analyses of thyroid function. GDM was diagnosed using a 2 hours, 75-g oral glucose tolerance test, and the mothers were grouped and compared according to the results. Results: The incidence of GDM in pregnant women tended to increase with age (P< .0001). The level of free T4 (FT4) in early pregnancy in GDM women was lower than that in non GDM women (P< .0001) also found that high maternal weight was associated with a higher GDM rate in the first trimester (P< .0001). Conclusion: Low thyroxine levels in early pregnancy could be a risk factor for GDM development.

Does severe vitamin D deficiency impact obstetric outcomes in pregnant women with thyroid autoimmunity?

Purpose: Vitamin D plays an important role in the modulation of the immune system and anti-autoimmune activities. Autoimmune thyroid diseases related to endocrine disorders are associated with poor obstetric outcomes in pregnancy. Herein, we aimed to investigate the contribution of vitamin D hypovitaminosis to poor pregnancy outcomes in pregnant women with the positive autoimmune antibody.Materials and methods: This was a prospective case–control study that enrolled pregnant women at their first trimester. The pregnant women were divided based on thyroid antibody (TA) status (TA-positive pregnant group (TAs (+)) and negative group (TAs (−)). Vitamin D status was categorized as sufficient, insufficient, and deficient (severe and moderate).Results: A total of 283 pregnant women were enrolled in this study. A total of 219 pregnant women were assigned to the TAs (−) group and 64 to the TAs (+) group. The rate of vitamin D insufficiency was 8.7, and 7.8% in the pregnant with TAs (−), and the pregnant with TAs (+) groups, respectively. Vitamin D deficiency was highly prevalent in all groups. Specifically, the prevalence rate was 91 and 92% in the pregnant with TAs (−) and the pregnant with TAs (+) groups, respectively. Admission to the neonatal intensive care unit (NICU) was more prevalent in the pregnant with TAs (+) group than in the pregnant with TAs (−) group (40.6 versus 25%; p = .0187; effect size (ES) = 0.134). The rate of gestational diabetes mellitus (GDM) was significantly higher in the pregnant women with TAs (+) group than that in the pregnant women with TAs (−) group (12.5 versus 4.1%; p = .03; ES =0.13). The rate of NICU admission and GDM was significantly higher in the severe vitamin D-deficient pregnant group with TAs (+) than that in the severe vitamin D-deficient pregnant group with TAs (−) (47 versus 23%; p = .007; ES =0.207 and 19.4% versus 4.1%; p = .006; ES =0.214, respectively).Conclusions: Severe vitamin D deficiency may contribute to increase the prevalence of GDM and need for NICU admission in pregnant women with positive TA.

Gestational diabetes incidence and delivery outcomes in Western China: A prospective cohort study.

Few studies have examined the age-standardized incidence of gestational diabetes mellitus (GDM) for comparison between populations. Information on delivery outcomes is also lacking for Chinese women with GDM. Therefore, the present study aimed to determine age-standardized GDM incidence and assess its association with maternal and neonatal outcomes. A total of 1901 pregnant women were recruited in Chengdu, Sichuan Province. GDM was diagnosed between 24 and 28weeks' gestation using oral glucose tolerance tests. Age-standardized incidence rates of GDM were calculated using the direct method. Delivery outcomes were extracted from medical records and compared between the GDM and non-GDM groups. The age-standardized GDM incidence was 18.3% (95% CI 15.6-21.1) and increased with maternal age and prepregnancy body mass index (BMI). Women with GDM experienced longer length of stay in hospital, shorter gestation at delivery, and a higher risk of cesarean delivery. Their newborns were more likely to be macrosomic or small for gestational age, and to require neonatal intensive care. The incidence of GDM was high in Western China, especially among older and overweight women. Moreover, women with GDM had higher rates of adverse delivery outcomes. The findings lend further support for the screening, prevention, and management of GDM in Chinese women.