scholarly journals ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects

2016 ◽  
Vol 174 (2) ◽  
pp. R43-R51 ◽  
Author(s):  
Baz Baz ◽  
Jean-Pierre Riveline ◽  
Jean-François Gautier
Keyword(s):  
Gestational Diabetes ◽  
Normal Pregnancy ◽  
Tolerance Test ◽  
Clinical Aspects ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Risk Alleles ◽  
Before And After ◽  
Normal Glucose ◽  
Adverse Pregnancy

Gestational diabetes (GDM) is defined as a glucose intolerance resulting in hyperglycaemia of variable severity with onset during pregnancy. This review aims to revisit the pathogenesis and aetiology of GDM in order to better understand its clinical presentation and outcomes. During normal pregnancy, insulin sensitivity declines with advancing gestation. These modifications are due to placental factors, progesterone and estrogen. In a physiological situation, a compensatory increase in insulin secretion maintains a normal glucose homeostasis. GDM occurs if pancreatic β-cells are unable to face the increased insulin demand during pregnancy. GDM is most commonly a forerunner of type 2 diabetes (T2D) – the most prevalent form of diabetes. These women share similar characteristics with predisposed subjects to T2D: insulin resistance before and after pregnancy, and carry more T2D risk alleles. Auto-immune and monogenic diabetes are more rare aetiologies of GDM. Adverse pregnancy outcomes of GDM are mainly related to macrosomia caused by fetal hyperinsulinism in response to high glucose levels coming from maternal hyperglycaemia. Screening recommendations and diagnosis criteria of GDM have been recently updated. High risk patients should be screened as early as possible using fasting plasma glucose, and if normal, at 24–28 weeks of gestation using 75 g oral glucose tolerance test. The treatment of GDM is based on education with trained nurses and dieticians, and if necessary insulin therapy.

scholarly journals Obesity in Gestational Diabetes: Emerging Twin Challenge for Perinatal Care in India

2010 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Evita Fernandez ◽  
Tarakeswari Surapaneni
Keyword(s):  
Gestational Diabetes ◽  
Perinatal Care ◽  
Tolerance Test ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Growth Monitoring ◽  
Glucose Levels ◽  
Glucose Challenge ◽  
Prevalence Of Obesity ◽  
Adverse Pregnancy

ABSTRACT The current study aimed to determine the prevalence of obesity and gestational diabetes (GDM) and the association of obesity and gestational diabetes with adverse pregnancy outcomes in a population of pregnant women. Routine antenatal care included the estimation of body mass indices, assessment of blood glucose levels, including glucose challenge tests and oral glucose tolerance test, fetal growth monitoring and nutritional counseling. The prevalence of GDM and obesity in this population was 8.43% (95% CI: 7.47-9.40) and 19.49% (95% CI: 18.12-20.87) respectively. The prevalence of obesity increased to 54.63% (95% CI: 52.91-56.36), if we used the ICMR guidelines for BMI in this population. Cesarean sections (adjusted OR: 2.04, 95% CI: 1.43-2.89), large for gestational age (LGA) babies (adjusted OR: 3.82, 95% CI: 2.11-6.92) and macrosomia (adjusted OR: 20.90, 95% CI: 3.29-132.77) was associated with obesity in GDM (based on the ICMR guidelines for BMI). Results from this study indicate that gestational diabetes and obesity are increasingly important priorities for perinatal care in India.

scholarly journals Gestational diabetes and fetal outcome: a study in a tertiary care centre

2017 ◽  
Vol 6 (10) ◽  
pp. 4458
Author(s):  
V. G. Vanamala
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Tertiary Care ◽  
Tolerance Test ◽  
Fetal Outcome ◽  
Oral Glucose ◽  
Tertiary Care Centre ◽  
Glucose Levels ◽  
The People ◽  
Urine Examination

Background: Due to urbanization and sedentary lifestyle, dietary changes, and increased obesity of the people, the incidence of GDM is steadily on the rise. It is associated with severe morbidity to the mother and the child. It is therefore imperative that an early diagnosis needs to be done so that appropriate treatment can be given.Methods: 1654 women who were included in the study were in their 24 – 28 weeks of gestation. A standardized questionnaire was formatted and details regarding the age, weight, body mass index (BMI), parity, previous medical and obstetrics history and familial history of diabetes, tests for glucose levels, complete blood picture, routine urine examination. Oral glucose tolerance test was done for all the patients after fasting overnight.Results: 87 (5.3%) of them were positive for OGTT and were considered to have Gestational Diabetes mellitus. 67.8% of the patients were in the 25-30 age group. 41.4% were pregnant for the first time and 58.6% were multi gravid. The majority of the patients had a BMI between 26-30. Most of the babies had a birth weight of above 3kgs. Out of them, 39 (44.8%) had a birth weight between 3.1-3.5kgs. <2kgs were seen in 7 (8.0%) patients.Conclusions: GDM complicates pregnancy and results in higher frequency of adverse effects in the mother and new born. Thereby, early detection can result in prompt treatment and lowering the morbidity of the fetal outcomes.

scholarly journals Maternal Dietary Patterns and Gestational Diabetes Risk: A Case-Control Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Fatemeh Sedaghat ◽  
Mahdieh Akhoondan ◽  
Mehdi Ehteshami ◽  
Vahideh Aghamohammadi ◽  
Nila Ghanei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Western Dietary Pattern ◽  
Increased Risk ◽  
Before And After

Background. Maternal dietary patterns play an important role in the progress of gestational diabetes mellitus (GDM). The aim of the present study was to explore this association.Method. A total of 388 pregnant women (122 case and 266 control) were included. Dietary intake were collected using a food frequency questionnaire (FFQ). GDM was diagnosed using a 100-gram, 3-hour oral glucose tolerance test. Dietary pattern was identified by factor analysis. To investigate the relation between each of the independent variables with gestational diabetes, the odds ratio (OR) was calculated.Results. Western dietary pattern was high in sweets, jams, mayonnaise, soft drinks, salty snacks, solid fat, high-fat dairy products, potatoes, organ meat, eggs, red meat, processed foods, tea, and coffee. The prudent dietary pattern was characterized by higher intake of liquid oils, legumes, nuts and seeds, fruits and dried fruits, fish and poultry whole, and refined grains. Western dietary pattern was associated with increased risk of gestational diabetes mellitus before and after adjustment for confounders (OR = 1.97, 95% CI: 1.27–3.04, OR = 1.68, 95% CI: 1.04–2.27). However, no significant association was found for a prudent pattern.Conclusion. These findings suggest that the Western dietary pattern was associated with an increased risk of GDM.

scholarly journals A study of gestational diabetes mellitus and fetal outcome in a tertiary care center

2020 ◽  
Vol 9 (8) ◽  
pp. 3417
Author(s):  
Aashka M. Mashkaria ◽  
Babulal S. Patel ◽  
Aastha M. Mashkaria ◽  
Akshay C. Shah ◽  
Shashwat K. Jani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Early Diagnosis ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Care Center ◽  
Tertiary Care ◽  
Tolerance Test ◽  
Fetal Outcome ◽  
Oral Glucose ◽  
Glucose Levels

Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers. 

scholarly journals Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia

2019 ◽  
Vol 16 (22) ◽  
pp. 4488 ◽  
Author(s):  
Emma L. Jamieson ◽  
Erica P. Spry ◽  
Andrew B. Kirke ◽  
David N. Atkinson ◽  
Julia V. Marley
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Time Course ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Rural And Remote ◽  
Glucose Levels

Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.

scholarly journals Impact of Implementing Preanalytical Laboratory Standards on the Diagnosis of Gestational Diabetes Mellitus: A Prospective Observational Study

2016 ◽  
Vol 62 (2) ◽  
pp. 387-391 ◽  
Author(s):  
Niamh Daly ◽  
Iseult Flynn ◽  
Ciara Carroll ◽  
Maria Farren ◽  
Aoife McKeating ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Sample Handling ◽  
Paired Samples ◽  
Adverse Pregnancy ◽  
Hospital Practices ◽  
Analysis Interval

Abstract BACKGROUND Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, but risk is reduced with identification and early treatment. Glucose measurements are affected by preanalytical sample handling, such as temperature of storage, phlebotomy–analysis interval, and use of a glycolysis inhibitor. We evaluated glucose concentrations and the incidence of GDM after strict implementation of the American Diabetes Association (ADA) preanalytical guidelines, compared with usual hospital conditions. METHODS Women screened selectively for GDM at 24–32 weeks' gestation were recruited at their convenience before a 75-g oral glucose tolerance test. Paired samples were taken: the first sample followed ADA recommendations and was transferred to the laboratory on an iced slurry for immediate separation and analysis (research conditions), and the second sample was not placed on ice and was transferred according to hospital practice (usual conditions). RESULTS Of samples from 155 women, the mean fasting, 1-h, and 2-h results were 90.0 (12.6) mg/dL [5.0 (0.7) mmol/L], 142.2 (43.2) mg/dL [7.9 (2.4) mmol/L], and 102.6 (32.4) mg/dL [5.7 (1.8) mmol/L], respectively, under research conditions, and 81 (12.6) mg/dL [4.5 (0.7) mmol/L], 133.2 (41.4) mg/dL [7.4 (2.3) mmol/L], and 99 (32.4) mg/dL [5.5 (1.8) mmol/L] under usual conditions (all P &lt; 0.0001). GDM was diagnosed in 38.1% (n = 59) under research conditions and 14.2% (n = 22) under usual conditions (P &lt; 0.0001). The phlebotomy–analysis interval for the fasting, 1-h, and 2-h samples was 20 (9), 17 (10), and 17 (9) min under research conditions and 162 (19), 95 (23), and 32 (19) min under usual conditions (all P &lt; 0.0001). All cases of GDM were diagnosed on fasting or 1-h samples; the 2-h test diagnosed no additional cases. CONCLUSIONS Implementation of ADA preanalytical glucose sample handling recommendations resulted in higher mean glucose concentrations and 2.7-fold increased detection of GDM compared with usual hospital practices.

A defect in insulin release in women at risk of future non-insulin-dependent diabetes

1991 ◽  
Vol 81 (2) ◽  
pp. 195-199 ◽  
Author(s):  
Anne Dornhorst ◽  
Simon G. M. Edwards ◽  
Jonathan S. D. Nicholls ◽  
Victor Anyaoku ◽  
Duncan Mclaren ◽  
...  
Keyword(s):  
Insulin Sensitivity ◽  
Gestational Diabetes ◽  
Plasma Glucose ◽  
Fasting Glucose ◽  
Glucose Production ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Control Subjects ◽  
Previous Gestational Diabetes

1. A study on seven Caucasian glucose-tolerant women with previous gestational diabetes and seven matched control subjects is presented. The insulin response to oral glucose, insulin sensitivity and fasting glucose production rates were measured by using a 75 g oral glucose tolerance test, an insulin tolerance test and a non-radioactive tracer, [6,6-2H]glucose, respectively. 2. Fasting plasma glucose levels were similar between the women with previous gestational diabetes and the control subjects (4.8 ± 0.3 versus 4.7 ± 0.2 mmol/l), as were fasting plasma insulin levels (median 4 m-units/l, range 1–13 m-units/l versus median 4 m-units/l, range 1–24 m-units/l). After oral glucose the 60 min plasma glucose levels in the women with previous gestational diabetes were significantly higher (8.5 ± 0.6 versus 6.7 ± 0.8 mmol/l, P < 0.05), whereas the plasma insulin level was significantly lower at both 30 min (median 23 m-units/l, range 4–47 m-units/l versus median 55 m-units/l, range 23–100 m-units/l, P < 0.02) and at 60 min (median 23 m-units/l, range 4–43 m-units/l versus median 60 m-units/l, range 16–126 m-units/l, P< 0.02). 3. Insulin sensitivity, expressed as the slope of the regression line of plasma glucose level against time after intravenous infusion of insulin (0.05 unit/kg), was similar in the women with previous gestational diabetes and the control subjects (mean slope, −0.17 ± 0.01 versus −0.17 ± 0.01). 4. Fasting glucose production rates were similar in the women with previous gestational diabetes and the control subjects (2.2 ± 0.3 versus 1.9 ± 0.1 mg min−1 kg−1). 5. Women with previous gestational diabetes, a group at risk of future non-insulin-dependent diabetes, have abnormalities of insulin release at a time when insulin sensitivity and fasting glucose production are normal.

Glucose tolerance in singleton, twin and triplet pregnancies

2016 ◽  
Vol 44 (8) ◽  
Author(s):  
Amir Weissman ◽  
Arie Drugan
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Challenge Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Glucose Challenge Test ◽  
Glucose Challenge ◽  
Mean Glucose ◽  
Twin Pregnancies

AbstractBackground:Data regarding the effects of multifetal pregnancy on the incidence of gestational diabetes mellitus (GDM) are inconsistent and even conflicting. Twin pregnancies have been associated with no increase, a marginal increase or a higher incidence of gestational diabetes. In triplet pregnancies, these effects have not been investigated yet.Objectives:To analyze the results of the glucose challenge and tolerance tests in singleton, twin and triplet pregnancies.Study design:A retrospective database analysis of pregnant women with singletons, twins or triplets who had complete results of the 50 g glucose challenge test (GCT) and the 100 g oral glucose tolerance test (OGTT). The cohort included 12,382 singletons, 515 twins and 39 triplets.Results:There were significantly higher rates of abnormal GCTs in twins and triplets compared to singletons (45.4% and 33.3%, respectively vs. 13.7%, P<0.001 and P<0.05). Significantly higher rates of gestational diabetes in twins (10.1% vs. 2.9 %, P<0.001) and triplets (12.8% vs. 2.9%, P<0.05) compared to singletons were observed. Mean glucose levels after the GCT were higher in twins compared to singletons, and even more in triplets (108 mg/dL in singletons vs. 120 mg/dL in twins vs. 129 mg/dL in triplets, P<0.001).Conclusions:Glucose intolerance is aggravated in multifetal pregnancies. The likelihood of an abnormal GCT and gestational diabetes is higher in twins and triplets compared to singletons.

scholarly journals Comparison of Birth Outcomes by Gestational Diabetes Screening Criteria

2018 ◽  
Vol 08 (04) ◽  
pp. e280-e288 ◽  
Author(s):  
Esa Davis ◽  
Christina Scifres ◽  
Kaleab Abebe ◽  
Tina Costacou ◽  
Diane Comer ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Birth Outcomes ◽  
International Association ◽  
Challenge Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Singleton Pregnancy ◽  
Screening Criteria ◽  
Iadpsg Criteria ◽  
Normal Glucose

Objectives This study is to examine the association between different diagnostic criteria for gestational diabetes mellitus (GDM) and adverse birth outcomes. Study Design A retrospective cohort study of 5,937 women with a singleton pregnancy was conducted, who completed GDM screening between 24 to 32 weeks gestational age. Four nonoverlapping groups of women defined as: 1) Normal: glucose challenge test (GCT) <130 mg/dL, 2) elevated GCT + normal oral glucose tolerance test (OGTT): abnormal 1 hour GCT + normal 3 hour OGTT, 3) GDM/International Association of Diabetes in Pregnancy Study Group (IADPSG): abnormal 3 hour OGTT by the IADPSG criteria, and 4) GDM/Carpenter-Coustan (CC): diagnosis per CC criteria. We used logistic regression to examine the association between GDM group classification and main outcome of macrosomia and secondary birth outcomes. Results Prevalences were GDM/CC 4.6%, GDM/IADPSG 3.0, and 7.6% overall. GDM/IADPSG group was associated with increased macrosomia (adj OR [odd ratio] 1.87; 95% CI [confidence interval]: 1.08–3.25; p = 0.02), while GDM/CC group was associated with increased preterm birth (adj OR 1.75; 95% CI: 1.05–2.80; p = 0.03). Conclusion Little difference in birth outcomes was found between the two criteria, GDM/CC and GDM/IADPSG. Randomized controlled trials are needed to clarify the risks and benefits of these screening paradigms before their incorporation into clinical practice.

scholarly journals Optimal first trimester HbA1c threshold to identify Singaporean women at risk of gestational diabetes mellitus and adverse pregnancy outcomes: A pilot study

2018 ◽  
Vol 12 (2) ◽  
pp. 79-84 ◽  
Author(s):  
Zi X Poo ◽  
Ann Wright ◽  
Du Ruochen ◽  
Ravinder Singh
Keyword(s):  
Diabetes Mellitus ◽  
Pilot Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnancy Outcomes ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Adverse Pregnancy

This pilot study examined the use of early HbA1c in screening for gestational diabetes mellitus and adverse pregnancy outcomes in Singapore. One hundred and fifty-one pregnant women with a gestational age of under 14 weeks had an HbA1c test measured with their antenatal bloods prior to a second trimester oral glucose tolerance test. Patient characteristics and pregnancy outcome data were collected. Gestational diabetes mellitus prevalence was 11%. A receiver operating characteristic curve showed an HbA1c level of 5.2% (33 mmol/mol), had an 82% sensitivity, 72% specificity, 97% negative predictive value and 27% positive predictive value to predict gestational diabetes mellitus. Women with HbA1c of 5.2% (33 mmol/mol) or over 5.2% (33 mmol/mol) were older, had higher BMI and were less likely to be Chinese than those with HbA1c less than 5.2% (33 mmol/mol). There was no difference in pregnancy outcomes. Early HbA1c less than 5.2% (33 mmol/mol) may be useful to exclude low-risk Singaporean women from further testing, while those with HbA1c of 5.2% (33 mmol/mol) or greater would still need a oral glucose tolerance test between 24 and 28 weeks’ gestation.

Sign in / Sign up

Export Citation Format

Share Document