“Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US: a network cohort analysis”

ABSTRACTOBJECTIVESTo describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza.DESIGNMultinational network cohortSETTINGA total of 6 databases consisting of electronic medical records and claims data from France, Spain, and the United States.PARTICIPANTSPregnant women with ≥ 1 year in contributing databases, diagnosed and/or tested positive, or hospitalized with COVID-19. The influenza cohort was derived from the 2017-2018 influenza season.OUTCOMESBaseline patient characteristics, comorbidities and presenting symptoms; 30-day inpatient drug utilization, maternal complications and pregnancy-related outcomes following diagnosis/hospitalization.RESULTS8,598 women diagnosed (2,031 hospitalized) with COVID-19 were included. Hospitalized women had, compared to those diagnosed, a higher prevalence sof pre-existing comorbidities including renal impairment (2.2% diagnosed vs 5.1% hospitalized) and anemia (15.5% diagnosed vs 21.3% hospitalized).The ten most common inpatient treatments were systemic corticosteroids (29.6%), enoxaparin (24.0%), immunoglobulins (21.4%), famotidine (20.9%), azithromycin (18.1%), heparin (15.8%), ceftriaxone (7.9%), aspirin (7.0%), hydroxychloroquine (5.4%) and amoxicillin (3.5%).Compared to 27,510 women with influenza, dyspnea and anosmia were more prevalent in those with COVID-19. Women with COVID-19 had higher frequency of cesarean-section (4.4% vs 3.1%), preterm delivery (0.9% vs 0.5%), and poorer maternal outcomes: pneumonia (12.0% vs 2.7%), ARDS (4.0% vs 0.3%) and sepsis (2.1% vs 0.7%). COVID-19 fatality was negligible (N<5 in each database respectively).CONCLUSIONSComorbidities that were more prevalent with COVID-19 hospitalization (compared to COVID-19 diagnosed) in pregnancy included renal impairment and anemia. Multiple medications were used to treat pregnant women hospitalized with COVID-19, some with little evidence of benefit. Anosmia and dyspnea were indicative symptoms of COVID-19 in pregnancy compared to influenza, and may aid differential diagnosis. Despite low fatality, pregnancy and maternal outcomes were worse in COVID-19 than influenza.WHAT IS ALREADY KNOWN ON THIS TOPICCompared to non-pregnant women of reproductive age, pregnant women are less likely to experience typical COVID-19 symptoms, such as fever and myalgia.Obesity, high maternal age, and comorbid hypertension and diabetes are risk factors for severe COVID-19 among pregnant women.Despite relatively high rates of pneumonia and need for oxygen supplementation, fatality rates in pregnant women with COVID-19 are generally low (<1%).WHAT THIS STUDY ADDSAlthough not often recorded, dyspnea and anosmia were more often seen in pregnant women with COVID-19 than in women with seasonal influenza, in 6 databases from 3 countries (US, France, Spain).Renal impairment and anemia were more common among hospitalized than diagnosed women with COVID-19 during pregnancy.Despite limited data on benefit-risk in pregnancy, a large number of medications were used for inpatient management of COVID-19 in pregnant women: approximately 1 in 3 received corticosteroids (some may have been given for a pregnancy-related indication rather than for COVID-19 treatment), 1 in 4 enoxaparin, and 1 in 5 immunoglobulin, famotidine and azithromycin.Compared to influenza, there was a higher frequency of pregnancy-related complications (cesarean section and preterm deliveries), as well as poorer maternal outcomes (pneumonia, acute respiratory distress syndrome, sepsis, acute kidney injury, and cardiovascular and thromboembolic events) seen in pregnant women diagnosed with COVID-19.

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Vaccination in pregnancy against pertussis and seasonal influenza: key learnings and components from high-performing vaccine programmes in three countries: the United Kingdom, the United States and Spain

BMC Public Health ◽

10.1186/s12889-021-12198-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Théophile Baïssas ◽

Florence Boisnard ◽

Inmaculada Cuesta Esteve ◽

Marta Garcia Sánchez ◽

Christine E. Jones ◽

...

Keyword(s):

United States ◽

United Kingdom ◽

Influenza Vaccination ◽

Pregnant Women ◽

Seasonal Influenza ◽

The United States ◽

Seasonal Influenza Vaccination ◽

High Performing ◽

The United Kingdom ◽

In Pregnancy

Abstract Background Pertussis and seasonal influenza are responsible for significant maternal, neonatal, and infant morbidity and mortality, but vaccine coverage rates (VCR) for both pertussis (administered as a tetanus, diphtheria, acellular pertussis [Tdap] vaccination) and seasonal influenza in pregnancy remain generally low. Only a small number of countries, including Spain, the United Kingdom (UK), and the United States (US), have high Tdap and seasonal influenza VCRs in pregnancy. The purpose of this study was to identify the key factors that contributed to the high VCRs observed in these countries. Methods The experience from both Tdap and seasonal influenza vaccination programmes during pregnancy were documented in Spain, the UK, and the US using a three-step approach. A literature review yielded 157 publications, and a further 117 documents were selected through desk research. A published five-pillar VCR framework for influenza was amended to evaluate the specific contributing factors leading to high Tdap and seasonal influenza VCRs among pregnant women. Results The analysis identified components that contributed to higher VCR in pregnant women across three different healthcare systems in Spain, UK, and US. The combination of several key interventions in each country led to a rapid increase in VCR that reached near-optimal levels (i.e. 75% for seasonal influenza) within a few years. As well as inclusion in national immunisation programme and vaccine reimbursement, key components that were identified included the mobilisation of health authorities, prenatal care Healthcare Professionals (HCP) and scientific societies, the inclusion of vaccination in antenatal medical guidance, the provision of educational material to HCPs, and a strong disease awareness driven by recent pertussis outbreaks in each country. Conclusions Although there is no simple, universal solution to improving sub-optimal VCRs, the list of components identified in this study from three countries with high-performing Tdap and seasonal influenza vaccination programmes provides a basis for public health and medical stakeholders in other countries to define strategies to successfully implement national vaccination programmes for pregnant women.

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Vaccination In Pregnancy Against Pertussis And Seasonal Influenza: Key Learnings And Components From High-Performing Vaccine Programmes In Three Countries: United Kingdom, The United States And Spain

10.21203/rs.3.rs-491336/v1 ◽

2021 ◽

Author(s):

Théophile Baïssas ◽

Florence Boisnard ◽

Inmaculada Cuesta Esteve ◽

Marta García Sánchez ◽

Christine E. Jones ◽

...

Keyword(s):

United States ◽

United Kingdom ◽

Influenza Vaccination ◽

Pregnant Women ◽

Seasonal Influenza ◽

The United States ◽

National Immunisation Programme ◽

Seasonal Influenza Vaccination ◽

High Performing ◽

In Pregnancy

Abstract Background: Pertussis and seasonal influenza are responsible for significant maternal, neonatal, and infant morbidity and mortality, but vaccine coverage rates (VCR) for both pertussis (administered as a tetanus, diphtheria, acellular pertussis [Tdap] vaccination) and seasonal influenza in pregnancy remain generally low. Only a small number of countries, including Spain, the United Kingdom (UK), and the United States of America (USA), have high Tdap and seasonal influenza VCRs in pregnancy. The purpose of this study was to identify the key factors that contributed to the high VCRs observed in these countries.Methods: The experience from both Tdap and seasonal influenza vaccination programmes during pregnancy were documented in Spain, the UK, and the USA using a three-step approach. A literature review yielded 157 publications, and a further 117 documents were selected through desk research. A published five-pillar VCR framework for influenza was amended to evaluate the specific contributing factors leading to high Tdap and seasonal influenza VCRs among pregnant women.Results: The analysis identified components that contributed to higher VCR in pregnant women across three different healthcare systems in Spain, UK, and USA. The combination of several key interventions in each country led to a rapid increase in VCR that reached near-optimal levels (i.e. 75% for seasonal influenza) within a few years. As well as inclusion in national immunisation programme and vaccine reimbursement, key components that were identified included the mobilisation of health authorities, prenatal care Healthcare Professionals (HCP) and scientific societies, the inclusion of vaccination in antenatal medical guidance, the provision of educational material to HCPs, and a strong disease awareness driven by recent pertussis outbreaks in each country.Conclusions: Although there is no simple, universal solution to improving sub-optimal VCRs, the list of components identified in this study from three countries with high-performing Tdap and seasonal influenza vaccination programmes provides a basis for public health and medical stakeholders in other countries to define strategies to successfully implement national vaccination programmes for pregnant women.

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High burden of anemia among pregnant women in Tanzania: a call to address its determinants

Nutrition Journal ◽

10.1186/s12937-021-00726-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bruno F. Sunguya ◽

Yue Ge ◽

Linda Mlunde ◽

Rose Mpembeni ◽

Germana Leyna ◽

...

Keyword(s):

Food Insecurity ◽

Pregnant Women ◽

Reproductive Age ◽

Gis Mapping ◽

Demographic And Health Surveys ◽

Health Coverage ◽

Nutritional Knowledge ◽

Women Of Reproductive Age ◽

Anemia In Pregnancy ◽

In Pregnancy

Abstract Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery.

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Managing asthma in pregnancy

Breathe ◽

10.1183/20734735.007915 ◽

2015 ◽

Vol 11 (4) ◽

pp. 258-267 ◽

Cited By ~ 19

Author(s):

Vanessa E. Murphy

Keyword(s):

Pregnant Women ◽

Inhaled Corticosteroids ◽

Action Plan ◽

Asthma Management ◽

Perinatal Outcomes ◽

List Type ◽

Night Time ◽

Exacerbation Rate ◽

Common Chronic Disease ◽

In Pregnancy

Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis.Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (FeNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according toFeNOand added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice.Key pointsAsthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy.Educational aimsTo identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.

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Screening of Diabetes in Pregnancy

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2021.60420 ◽

2021 ◽

Author(s):

Barış Sever ◽

Halil Gürsoy Pala

Keyword(s):

Pregnant Women ◽

Diagnostic Criteria ◽

International Association ◽

Threshold Value ◽

Study Groups ◽

The United States ◽

Population Characteristics ◽

Diabetes In Pregnancy ◽

Screening Programs ◽

In Pregnancy

The prevalence of gestational diabetes mellitus (GDM) is approximately 6% of pregnant women in the United States. The prevalence ranges is about from 2% to 38% worldwide and varies among racial-ethnic groups, often paralleling the prevalence of type 2 diabetes. The prevalence also varies due to differences in screening practices, population characteristics (eg, mean age and body mass index [BMI] of pregnant women), testing method, and diagnostic criteria. The prevalence is increasing over time, possibly due to increases in mean maternal age and weight, particularly with increasing obesity. In 2010, the International Association of Diabetes and Pregnancy Study Groups proposed new screening and diagnostic criteria for diabetes in pregnancy. Using these criteria, the global prevalence of hyperglycemia in pregnancy is estimated at 17%, with regional estimates ranging from 10% in North America to 25% in Southeast Asia. Different screening programs are carried out in different clinics, and all these differences lead to different results in the frequency of GDM. The criteria of the method and threshold value acceptance depends on the health policies of the countries, the experience of the clinicians and the characteristics of the patient population. In this review, we analyzed the methods recommended for GDM screening in pregnancy.

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Fetal and Maternal Outcome Asymptomatic vs. Symptomatic Covid Positive Pregnant Women

10.53350/pjmhs2115103423 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3423-3425

Author(s):

Amna Najam ◽

Samreen Fakeer Muhammad ◽

Samia Saifullah ◽

Maryam Shoaib ◽

Maria Anwar

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Apgar Score ◽

Adverse Outcomes ◽

Maternal Outcomes ◽

Group A ◽

Nicu Admission ◽

Group B

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

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CLINICAL CHARACTERISTICS AND FETO-MATERNAL OUTCOMES IN PREGNANT WOMEN WITH COVID -19 INFECTIONS

10.36106/ijsr/6704051 ◽

2021 ◽

pp. 30-32

Author(s):

Gulshan Bano ◽

Anubha Prashad ◽

Rakhee Soni ◽

Mohammed Mishal

Keyword(s):

Pregnant Women ◽

Cesarean Delivery ◽

Clinical Features ◽

Clinical Characteristics ◽

Maternal Outcomes ◽

Hypertensive Disorder ◽

Co Morbidity ◽

Hypertensive Disorder Of Pregnancy ◽

The Mean ◽

In Pregnancy

Background and objectives:-COVID-19 is ongoing pandemic, caused by novel Corona Virus. There is very scarce information is available about clinical features and feto-maternal outcomes of COVID-19 in pregnancy. Therefore, this study was aimed to determine clinical characteristics and feto-maternal outcomes of pregnant women with COVID-19. Methods- In this retrospective study, we included all pregnant women admitted with COVID-19 over three months. Clinical features, laboratory ndings and feto-maternal outcomes were assessed.Results:-The mean age of the patients was 24 years. Hypertensive disorder of pregnancy was most common associated co-morbidity. Majority of patients (81%) were asymptomatic. Lymphocytopenia was seen in 58% of the patients and 47% had elevated levels of CRP. All patients who presented in rst trimester had spontaneous abortion. There is relatively higher rate of preterm birth (21%) and cesarean delivery(43%). All the neonates were tested negative for COVID-19. Conclusion;- There is relatively higher rate of cesarean delivery. Overall feto-maternal outcome was good and there was no evidence of vertical transmission.

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Seasonal Influenza Vaccination Patterns Among Pregnant Women in New Mexico

Hispanic Health Care International ◽

10.1177/1540415319896254 ◽

2019 ◽

Vol 18 (4) ◽

pp. 214-223

Author(s):

Upasana Chalise ◽

Jill A. McDonald ◽

Anup Amatya ◽

Martha Morales

Keyword(s):

Health Care ◽

New Mexico ◽

Influenza Vaccination ◽

Pregnant Women ◽

Seasonal Influenza ◽

Vaccine Coverage ◽

The United States ◽

Vaccination Rate ◽

Seasonal Influenza Vaccination ◽

Border States

Introduction: Seasonal influenza vaccination is recommended for pregnant women, but half of the pregnant women in the United States remain unvaccinated. Vaccine coverage in U.S.–Mexico border states has not been examined in depth even though risk factors for low vaccine coverage exist in these states, especially in the counties bordering Mexico. Method: Using 2012-2014 New Mexico (NM) Pregnancy Risk Assessment and Monitoring System data, this study examined the weighted annual seasonal influenza vaccination rates and the relationship of various factors to vaccination among NM residents with a live birth during those years. Results: Among respondents, 53.8% were Hispanic, 15.7% were Native American, and 30.5% were non-Hispanic White. The vaccination rate in NM increased from 49.0% in 2012 to 64.8% in 2014. The adjusted odds of vaccination were higher among women whose health care provider recommended/offered vaccination during the year prior to delivery compared to women whose provider did not (AOR = 11.92, 95% confidence interval [CI: 9.86, 14.42]) and among those living in the U.S.–Mexico nonborder counties compared to those living in the border counties (AOR = 1.23, 95% CI [1.18, 1.25]). Conclusion: Efforts to increase the vaccination rate among pregnant women in border states should concentrate on health care providers and the highest risk women, such as those resident in the border region.

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Mapping of anaemia prevalence among pregnant women in Kenya (2016–2019)

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03380-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Julius Nyerere Odhiambo ◽

Benn Sartorius

Keyword(s):

Pregnant Women ◽

Negative Binomial ◽

Optimal Allocation ◽

Policy Implications ◽

Reproductive Age ◽

Maternal Outcomes ◽

Health Coverage ◽

Maternal Anaemia ◽

Conditional Autoregressive ◽

Spatio Temporal

Abstract Background Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019. Methods Quarterly reported sub-county level maternal anaemia cases from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical negative binomial spatio-temporal conditional autoregressive (CAR) model was used to estimate maternal anaemia prevalence by sub-county and quarter. Spatial and temporal correlations were considered by assuming a conditional autoregressive and a first-order autoregressive process on sub-county and seasonal specific random effects, respectively. Results The overall estimated number of pregnant women with anaemia increased by 90.1% (95% uncertainty interval [95% UI], 89.9–90.2) from 155,539 cases in 2016 to 295,642 cases 2019. Based on the WHO classification criteria, the proportion of sub-counties with normal prevalence decreased from 28.0% (95% UI, 25.4–30.7) in 2016 to 5.4% (95% UI, 4.1–6.7) in 2019, whereas moderate anaemia prevalence increased from 16.8% (95% UI, 14.7–19.1) in 2016 to 30.1% (95% UI, 27.5–32.8) in 2019 and severe anaemia prevalence increased from 7.0% (95% UI, 5.6–8.6) in 2016 to 16.6% (95% UI, 14.5–18.9) in 2019. Overall, 45.1% (95% UI: 45.0–45.2) of the estimated cases were in malaria-endemic sub-counties, with the coastal endemic zone having the highest proportion 72.8% (95% UI: 68.3–77.4) of sub-counties with severe prevalence. Conclusion As the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy. By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets.

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PRACTICAL SCREENING FOR DIABETES MELLITUS IN PREGNANT WOMEN

Acta Endocrinologica ◽

10.1530/acta.0.075s011 ◽

1974 ◽

Vol 77 (3_Suppl) ◽

pp. S11-S24 ◽

Cited By ~ 29

Author(s):

Eigil Guttorm

Keyword(s):

Pregnant Women ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Screening Method ◽

Control Group ◽

List Type ◽

Fasting Plasma ◽

Class B ◽

Close Relatives ◽

In Pregnancy

ABSTRACT A prospective and consecutive investigation of 1697 pregnant women without earlier known diabetes and a retrospective investigation of 120 pregnant diabetics (White class A: 94, White class B: 26), has been performed. It was found that: the most useful criteria of potential diabetics were: 1) the presence of diabetes in close relatives, diagnosed before the age of 40 years, 2) the presence of obesity in the patients, defined as 20 per cent overweight or more just before pregnancy, 3) previous delivery of a big baby, defined as a baby with birthweight ≦ 4500 g. Of the 1697 pregnant women 8 per cent were potential diabetics and in 8 per cent glucosuria was found. pregnant women with glucosuria and potential diabetics defined as above had a higher risk of having a diabetic OGTT than other pregnant women. A diabetic OGTT was found with falling incidence in the groups: potential diabetics with glucosuria: 10.5 per cent, non-potential diabetics with glucosuria: 3.7 per cent, potential diabetics without glucosuria: 3.4 per cent, and in the control group (non-potential diabetics without glucosuria): 0.3 per cent. A positive correlation was found between the level of fasting plasma glucose (FPG) early in pregnancy, and the result of OGTT later in pregnancy. When FPG exceeded 89 mg/100 ml (75 mg/100 ml whole blood) the incidence of diabetic curves increased significantly. By combining the following criteria: potential diabetics – glucosuria – fasting plasma glucose, FPG, it was found that the percentage of pregnant women, which ought to be investigated with an OGTT, could be reduced to 4 per cent, while the sensitivity and the specificity of the screening was 78 per cent and 89 per cent, respectively. This approach also resulted in the detection of all the most treatmentrequiring cases of diabetes. The practical use of the screening method is described.

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