The Obstetrician's Role in Pregnant Women's Decision-Making Process Regarding Influenza and COVID-19 Vaccination.

Pregnant women are considered to be a population vulnerable to influenza and COVID-19 infections, and the latest guidelines consistently recommend that they receive influenza and COVID-19 vaccinations. A cross-sectional questionnaire-based study was conducted among pregnant women in Poland to determine which factors have the greatest impact on their decision to vaccinate against influenza and COVID-19. A total of 515 pregnant women participated in the study. Among them, 38.4% (n = 198) demonstrated a positive attitude toward influenza vaccination, and 64.3% (n = 331) demonstrated a positive attitude toward COVID-19 vaccination. Logistic regression analysis revealed that the strongest influence on positive attitudes toward COVID-19 vaccination is having it recommended by an obstetrician-gynecologist (OR = 2.439, p = 0.025). The obstetrician-gynecologist's recommendation to vaccinate against influenza also significantly influences the decision to vaccinate (OR = 5.323). The study results also show a strong correlation between the obstetrician-gynecologist as a source of information on influenza and vaccination and participants' positive attitudes toward vaccination (OR = 4.163). Obstetricians have a significant influence on pregnant women's decisions regarding vaccinations. Further recommendations to vaccinate and awareness-raising among obstetricians may be needed to increase the vaccination rate of pregnant women in Poland.

Physical Activity during Preconception Impacts Some Maternal Outcomes-A Cross-Sectional Study on a Population of Polish Women.

BACKGROUND: Physical activity is an element of a healthy lifestyle and is safe in most pregnancies. The aim of this study was to assess the impact of physical activity levels before and during pregnancy on pregnancy outcomes for both the mother and child. METHODS: A cross-sectional survey was conducted on a population of Polish women. An anonymous questionnaire was distributed electronically via maternity and parental Facebook groups. RESULTS: The final research group included 961 women. The analysis showed that physical activity 6 months before pregnancy was associated with a lower risk of gestational diabetes mellitus (GDM), but physical activity during pregnancy showed no such association. In all, 37.8% of women with low activity in the first trimester, in comparison to 29.4% of adequately active women, gained an excessive amount of weight during pregnancy (p = 0.0306). The results showed no association between activity level and pregnancy duration, type of delivery or newborn birth weight. CONCLUSIONS: Our study indicates that physical activity during the preconception period is crucial to GDM occurrence.

The attitude of Polish women planning pregnancy and/or having children towards vaccinations: a cross-sectional survey study.

OBJECTIVES: Infectious diseases in pregnant women can cause birth defects. Implementing appropriate prevention methods while planning pregnancy can help avoid some of them. MATERIAL AND METHODS: A cross-sectional survey study was performed. The questionnaire investigated attitudes towards vaccinations, as well as opinions on anti-vaccine movements and the so-called "chickenpox parties". The questionnaire was developed for the purpose of this study and the survey was conducted using the google form, which was posted on social media groups for women planning pregnancy, being pregnant or for mothers' groups from Poland. RESULTS: The study group consisted of 2402 women; their median age was 31 years (range 16-54 years). Most women were from cities > 100,000 inhabitants (49.7%, 1194/2402) and had higher education (71.9%, 1726/2402). A positive attitude towards vaccinations was more common among younger, nulliparous women from big cities (p = 0.02, p = 0.04 and p = 0.01, respectively). 2068/2402 (86.1%) of respondents were not vaccinated before pregnancy and 1931/2402 (80.4%) of women were not vaccinated during pregnancy. While most women (1545/2402, 64.3%) considered vaccination safe, and effective (1904/2402, 79.3%) against infectious diseases, many (n = 296/2402 12.3%) have no opinion on the so-called chickenpox party. CONCLUSIONS: Most surveyed women had a positive attitude towards vaccinations and consider vaccines a safe and effective method of protection against infectious diseases. Since a significant proportion of women were not vaccinated before or during pregnancy and about 12% of women are undecided, the physician's role is crucial in educating and persuading the patient to be vaccinated.

Pregnant Women's Knowledge of and Attitudes towards Influenza Vaccination during the COVID-19 Pandemic in Poland.

Pregnant women are more susceptible to influenza virus infections due to the immunological and physiological changes in the course of pregnancy. Vaccination during pregnancy is a safe and effective method for protecting both the mothers and the infants from influenza and its complications. This study was conducted in order to determine the knowledge and attitudes of Polish pregnant women towards influenza vaccination during the COVID-19 pandemic. A questionnaire-based and self-administered study was carried out fully online and a total of 515 women participated. A total of 52% (n = 268) of surveyed women answered that vaccination against influenza during pregnancy was safe. However, only 21% (n = 108) were vaccinated against influenza during their current pregnancy and 17.5% (n = 90) intended to be vaccinated. The participants indicated many concerns about getting vaccinated during pregnancy, but also many benefits that come with the vaccination. General knowledge about influenza, its complications, and vaccination was quite high in the study group.

Results of expectant management in singleton and twin pregnancies complicated by preterm premature rupture of membranes.

OBJECTIVES: This study aimed to examine whether expectant management in twin pregnancies with preterm premature rupture of membranes (pPROM) is as safe as in singleton pregnancies. MATERIAL AND METHODS: It was a retrospective cohort study comparing pregnancy course and outcome in singleton (n = 299) and twin pregnancies (n = 49) complicated by preterm premature rupture of membranes. Analysed factors included maternal diseases, gestational age at premature rupture of membranes (PROM), management during hospitalization, latency periods between PROM and delivery, gestational age at delivery, neonatal management and outcome. RESULTS: The difference in the proportion of patients with latency up to 72 hours, latency between 72 hours and seven days, and latency exceeding seven days were insignificant. The percentage of patients who received intravenous tocolysis and antenatal corticosteroids were similar; however, patients in twin pregnancies more often received incomplete steroids dose (p = 0.01). The occurrence of the positive non-stress test result and signs of intrauterine infection were similar between the groups. No statistically significant differences in the prevalence of neonatal complications except transient tachypnoea of the newborn were identified (24% in the singleton vs 13% in the twin group, p = 0.03). CONCLUSIONS: Expectant management of pPROM in singleton and twin pregnancies results in similar perinatal and neonatal outcome. Consequently, in case of no evident contraindications, expectant management of twin pregnancies seems to be equally as safe as in singleton pregnancies. Patients in twin pregnancies may be at higher risk of delivery before administration of full antenatal corticosteroids dose, therefore require immediate management initiation and transfer to a tertiary referral centre.

The impact of COVID-19 pandemic on reproductive intentions among the Polish population.

OBJECTIVES: The study was conducted in order to determine the impact of the COVID-19 pandemic on the fertility intentions among the Polish population. MATERIAL AND METHODS: A cross-sectional, questionnaire-based online study was carried out among Polish adults in order to determine the impact of the COVID-19 pandemic on the reproductive plans of the Polish society. A total of 984 participants correctly completed the survey. RESULTS: The pandemic has affected the reproductive intentions of 22% (n = 216) of the respondents, most of them want to have a child later than they previously planned (74.1%). The relationship between the change in reproductive intentions and the concerns about the pandemic was found. Most of those who changed their plans were afraid that the access to prenatal care and delivery services could be limited (86.6%) or were afraid about giving birth at the hospital (81%). More than half (51.9%) of those who changed reproductive plans were afraid of losing their income and 40.3% had already experienced a decrease in their income. The change in partner's emotional relationships was also observed. More than half of respondents (56.7%) admitted that during the pandemic they had developed a deeper emotional relationship with their partners or felt more emotionally supported (56.6%). Most participants responded that the frequency of their sexual intercourses was not affected (66.7%) and that they had not experienced limited access to contraceptives (95.1%) during the pandemic. CONCLUSIONS: The COVID-19 pandemic has affected Polish people's reproductive intentions. Concerns related to healthcare access and the economic difficulties have the most significant impact.

Difficulties in the management of hypokalemia in a pregnant patient with Gitelman syndrome.

Gitelman syndrome (GS) is a rare renal disorder, and little is known about its impact on pregnancy. We report the successful outcome of pregnancy in a patient with GS that was managed with aggressive oral and intravenous potassium supplementation.

Vulvar cancer in a patient with long-lasting premalignant lesions in the genital area: easily overlooked and difficult to diagnose - a case report and literature review.

Vulvar intraepithelial lesions are a heterogenic group of diseases, which can be easily misdiagnosed. The case of a 61-year-old woman with a history of genital intraepithelial lesions and infection with HPV is presented. Her main complaint was vulvar pruritus. Vulvoscopy revealed the presence of two skin lesions: the first one had the morphology of lichen sclerosus, and the second of a Bowenoid lesion. The biopsy of the first lesion revealed vulvar intraepithelial neoplasia, whereas cells of squamous vulvar cancer were identified in the second lesion. After staging, the patient was advised to undergo hemivulvectomy and lymphadenectomy. The coexistence of morphologically diverse vulvar skin lesions may cause difficulties with diagnosis and the selection of an adequate treatment. Long-term follow-up and regular examination are essential for diagnosis of vulvar malignancies in the early stage.

Knowledge, opinions and attitudes of Polish women towards banking and donation of human breast milk.

OBJECTIVES: The aim of the study was to obtain information on the knowledge, opinions and attitudes of Polish women in terms of functioning of human milk banks, as well as the possibility to be a donor. Specific objectives included consideration of responses in the sociodemographic aspect and identification of factors influencing donation decisions. MATERIAL AND METHODS: A cross-sectional survey was conducted, obtaining 871 responses. Women were asked to provide basic sociodemographic data, information related to pregnancy and lactation. Knowledge and opinion about breast milk banks as well as the impact of various factors on a potential donation decision were investigated. RESULTS: Of all women participating in the study, 604 (69%) were aware of the breast milk banks existence. 69% of respondents indicated the Internet, 10% - a nurse or midwife, while only 4% - a doctor as source of knowledge about human breast milk donation. Among women who had children (n = 453), only 9 (2%) donated breast milk in the past. The indicated reasons for not donating were no milk excess (38%), insufficient knowledge about the procedure or unawareness of its existence (33% and 25%, respectively), long distance to affiliated facility (17%). CONCLUSIONS: The awareness of breast milk banks existence, possibilities and terms of donation in the studied group is not satisfactory. Widely sharing reliable information on banking and promoting the idea of donating human breast milk in society can lead to impressive results. There is a need for further development of human breast milk banks and continuous improvement of their availability in Poland.

Physical activity during pregnancy - the state of Polish women's knowledge.

OBJECTIVES: Regular and moderate physical activity during uncomplicated pregnancy has been considered beneficial for both the expectant mother and her unborn child. It reduces the risk of gestational diabetes mellitus (GDM) and preeclampsia. The aim of the study was to assess women's knowledge concerning specific aspects of physical activity during uncomplicated pregnancy. MATERIAL AND METHODS: A cross-sectional survey study on a sample of Polish women in a tertiary referral centre was performed. A questionnaire that was validated in the Polish language was based on the Committee Opinion of American College of Obstetricians and Gynaecologists, which was published in December 2015. Sociodemographic parameters in relation to specific aspects of physical activity during pregnancy were analysed. RESULTS: A total of 259 (92.5%) women were aware of the beneficial impact of physical activity on the course of pregnancy. Higher education was associated with greater awareness (p = 0.001). Regarding the optimal frequency and recommended duration of exercise, the overall rates of correct answers were only 106 (38.1%) and 167 (59.6%), respectively. The most common sources of information on physical activity during pregnancy were the Internet (81, 50.0%) and books (62, 38.3%). Doctors and midwives instructed the respondents only in 36 (22.4%) and 31 (18.9%) cases, respectively. CONCLUSIONS: Women's knowledge about physical activity during pregnancy seems satisfactory. However, awareness concerning the optimal duration and frequency of exercise, as well as recommended voluntary activities during pregnancy, should be improved. Medical professionals may also reinforce their role as a provider of reliable information, resulting in the prevention of many pregnancy complications.

Women's attitude towards umbilical cord blood banking in Poland.

Umbilical cord blood (UCB) is considered as a valuable potential source of hematopoietic stem and progenitor cells. A process of collecting and storing UCB in the immediate period after the birth is called UCB banking. The study was conducted in order to determine women's knowledge, awareness, preferences and attitude towards UCB banking in Poland, considering the sociodemographic and obstetric factors. A cross-sectional, self-administered, online questionnaire-based study including mostly multiple choice questions concerning attitude and awareness regarding UCB banking was conducted entirely online among Facebook female users in Poland. A total of 1077 participants correctly completed the survey. Most participants (n = 911, 84.6%) were aware of the possibility of UCB banking. Social media were considered as the main source of information (47.5%). However, the participants mostly indicated the doctor as their preferred source of reliable information (86.8%). The majority of women (61.8%) assessed their level of knowledge of UCB banking as still insufficient. Among the participants who supported UCB banking (70%), the following reasons were considered as the most vital: potential possibility of helping their child (93.9%) and helping other relatives (64.4%). More than half of the respondents (66.9%), who have not stored and are not willing to store their children's UCB, indicated the high cost of UCB banking as the main reason of this decision. The knowledge and awareness of UCB storage and banking possibilities amongst women in Poland could be improved. The professional medical personnel should be a source of reliable information.

Gestational weight gain and glycemic control in GDM patients with positive genital culture.

OBJECTIVE: Gestational diabetes mellitus (GDM) is related to many complications of pregnancy. The aim of the study was the assessment of cervical colonization in GDM patients and its correlation with inappropriate glycaemic control and gestational weight gain (GWG). MATERIALS AND METHODS: The study included 483 women with GDM in a singleton pregnancy who delivered at term. Cervical smears samples were collected >35th week of gestation and cultured for aerobic and aerobic bacteria, and fungi. The patients were divided into two groups on the basis of cervical culture test results: women with negative and positive cervical culture results. Gestational weight gain was estimated in both groups as inadequate, adequate or excessive based on pre-gestational body mass index (BMI) according to the Institute of Medicine (IOM) guidelines. GWG and need of insulin therapy were used as an indicator of complying with dietary recommendations. RESULTS: Patients with positive cervical culture results more frequently had pre-pregnancy BMI >35kg/m2 (4.9% vs 9.5%, p = 0.0508) than patients who had negative cervical culture results. One third (32.1%) of patients had one, and 9.3% had at least two microorganisms in their genital tracts. The most frequent bacteria species isolated was Streptococcus agalactiae (20.1%). Fungi were present in 14.1% of the cervical cultures. Patients with GDM with inadequate GWG more often had genital tract's colonization with Enterococcus spp. (6.83% vs. 1.19% vs. 1.83%, in group with inadequate GWG vs. adequate GWG vs. excessive GWG respectively p = 0.007). CONCLUSION: Insulin therapy in GDM patients was not correlated with the presence of microorganisms in genital tracts. Inadequate GWG in GDM may be linked to genital tract colonization with Enteroccocus spp. Genital colonization during pregnancy among patients with GDM is more often among patients' with pre-pregnancy BMI >35 kg/m2.

Risk factors for unsuccessful vaginal birth after caesarean at full dilatation.

OBJECTIVES: The purpose of this study was to determine the risk factors for caesarean sections in the second stage of labour after a previous caesarean section among women who underwent trial of labour (TOL). MATERIAL AND METHODS: From a total of 639 women who experienced one caesarean section, 456 women were qualified for TOL. From this group, 105 women were subjected to a caesarean section in the first stage of labour and another 351 women reached the second stage of labour. From the latter group, 309 women delivered naturally and 42 were subjected to a caesarean section. RESULTS: Risk factors for the necessity of performing a caesarean section in the second stage of labour after a previous caesarean section was the weight gain during pregnancy (OR = 1.07), the height of fundus uteri (OR = 1.25) before delivery, and the estimated foetal weight (OR = 1.01), a past delivery of a child with a birth weight exceeding 4.000 g (OR = 2.14), the presence of pre-gestational diabetes (OR = 15.4) and gestational diabetes (OR = 2.22), necessity of applying a delivery induction (OR = 2.52), stimulation of uterine activity during delivery (OR = 2.43) and application of epidural analgesia (OR = 4.04). A factor reducing the risk of a caesarean section in the second stage was a vaginal delivery in a woman's history (OR = 0.21). CONCLUSIONS: Women should be encouraged to deliver naturally after a previous caesarean section, especially when their history includes a vaginal delivery and if there is no need for labour induction.

Comparison of maternal characteristics, pregnancy course, and neonatal outcome in preterm births with and without prelabor rupture of membranes.

OBJECTIVES: The aim of this study was to evaluate pregnancy outcome of patients with prelabor rupture of membranes receiving expectant management and giving birth prematurely in comparison to preterm births of patients with intact membranes. MATERIAL AND METHODS: It was a retrospective cohort study comparing maternal and neonatal outcome in two groups of preterm births. The first group included 299 consecutive singleton preterm births complicated by prelabor rupture of membranes. The second group consisted of 349 consecutive singleton preterm births without prelabor rupture of membranes. RESULTS: Patients without pPROM underwent Caesarean sections more often than women from the pPROM group (65.3% vs 45.2%; p < 0.001). No statistically significant differences regarding the gestational age during delivery were identified. Lower birth weight was detected in the group with no history of pPROM (p < 0.001). No differences regarding early-onset sepsis were identified and higher percentage of late-onset infections was observed in infants with no history of pPROM (8.9% vs 4.7%; p = 0.04). Pulmonary hypertension was more common in the infants from the pPROM group (4% vs 1.4%; p = 0.049). Neonatal respiratory distress syndrome and respiratory failure were more prevalent in cases of no pPROM history - 20% vs 12.7% (p = 0.02) and 40% vs 25.8% (p < 0.001), respectively. CONCLUSIONS: Development of multiple complications in preterm neonates may be more associated with the management, gestational age at birth, and birth weight than with the occurrence of preterm prelabor rupture of membranes.

Does the status quo have to remain? The current legal issues of transsexualism in Poland.

Transsexual persons often undergo the process of transition, which is a long, multi-stage procedure. One of the stages, often final, is the lawful reassignment of sex, which is often perceived by transsexual individuals as more meaningful than the medical interventions. The aim of the study was to analyze the current legal situation of transsexual individuals in Poland. An in-depth review of legal documents and their association with current medical knowledge on transsexualism together with a presentation of solutions established worldwide were performed. Analyzed aspects include surgical interventions, sex assignment and correction of birth certificate. The current legal situation of lawful sex reassignment in Poland is complex and far from friendly towards transsexual people. Recent attempts to improve the situation were unsuccessful and current strategies to help transsexual people seem to be ineffective. Apart from the medico-legal problems, a number of issues connected with transgenderism depend on the socio-political views. The most notable drawback of the currently binding judicial procedure of legal sex change is the requirement of suing parents, spouse and children. This could be avoided if the change was performed in a non-litigious mode of proceedings, in which the medical criteria of the World Health Organization (WHO) and an opinion of a strictly regulated team of experts were central factors.

Palliative treatment of intestinal obstruction in patients with gynecologic malignancies - single center experience.

OBJECTIVES: One of the common symptoms in patients with advanced gynecologic tumors is intestinal obstruction. Palliativemanagement may include pharmacological treatment, stenting as well as surgical removal of obstruction cause.Selection of appropriate treatment should be based on careful and individual assessment of advantages, disadvantagesand possible complications. The aim of the study was to analyze the effectiveness of non-invasive treatment in patientswith gynecologic malignancies suffering from intestinal obstruction. MATERIAL AND METHODS: It was a retrospective analysis of factors associated with primary non-invasive intestinal obstructiontreatment effectiveness. Data were collected from medical records of 17 patients managed and followed-up in a singlegynecologic oncology center due to endometrial cancer, fallopian tube cancer, uterine leiomyosarcoma, and ovarian canceradmitted to the ward because of symptomatic intestinal obstruction. Mean observation time lasted 40.6 months. Non-invasivetreatment included fluid therapy, dexamethasone, buscolysin, mebeverine, ranitidine, simethicone, omeprazole,magnesium sulphate, semi-liquid diet, and parenteral nutrition. Characteristics including age, BMI, comorbidities, oncologicaltreatment, histology type, stage, grade, presence of ascites, location of primary tumor and metastases were analyzed. RESULTS: The number of obstruction episodes varied from 1 to 5. Mean time between multiple episodes lasted 3.2 months. 5 patientsrequired surgical treatment. For the rest of the patients primary non-invasive treatment was sufficient. CONCLUSIONS: Most cases of bowel obstruction in patients with advanced gynecologic malignancies can be successfullymanaged without invasive treatment. Moreover, non-invasive obstruction management can be applied multiple times incase of recurrence.

Pregnant surgeon - assessment of potential harm to the woman and her unborn child.

Although most countries developed regulations concerning pregnant women at work, they are not strictly adjusted forevery profession. In the European countries directives prevent pregnant women from working during night shifts, but apartfrom a vague paragraph about avoiding hazardous agents, there are no guidelines specific for pregnant surgeons. The aimof the study was to analyse the risks and consequences of working in the operating theatre during pregnancy. An in-depthanalysis of available literature, laws and regulations concerning health and safety of pregnant surgeons was performed. Notonly they are surgeons exposed to radiation and infectious agents like any other physicians, but they also face the risk ofstrenuous physical activity affecting their pregnancy. The unpredictability of this occupation, prolonged hours and stressassociated with work can all affect the future mother and her child. The available research on potential risks for pregnantwomen performing surgical activities named such consequences as premature birth, miscarriage, foetal growth retardation,hypertensive disorders and infertility. There are no unanimous guidelines for pregnant surgeons on how long and to whichextent they should work. The key is to maintain a balance between limiting the likelihood of pregnancy complications andrespecting women's voluntary wish to continue professional development.

Secondary cervical cancer prevention in routine prenatal care - coverage, results and lessons for the future.

OBJECTIVES: Cervical cancer is the fourth most common type of cancer among women worldwide and one of the most common malignancies diagnosed in gravidas. Therefore, routine antenatal Pap smear is such an important examination. The aim of the study was to assess the prevalence of Pap smear performance during prenatal care and to determine possible factors affecting it. MATERIAL AND METHODS: A self-composed questionnaire was distributed among 638 women managed in a tertiary obstetric referral center. 33 questions regarded cervical cancer prevention and risk factors. RESULTS: 96.9% of respondents had undergone Pap smear and 80.6% had it performed during pregnancy. For 11.5% women Pap smear in pregnancy was the first one in their life. The most common reasons for lack of Pap smear performance were: no subjective need to perform it (40.9%), no doctor's recommendation (28.6%) and lack of gynecological care (16.3%). Among professionally active women the percentage of those who had not undergone Pap smear during pregnancy was statistically higher (28.5%) than among those who were on sick leave (13.5%) (p = 0.0003). Also, younger women were at risk of less frequent participation in cervical cancer screening CONCLUSIONS: Although performance of Pap smear among surveyed patients was relatively high, there was a significant group of women who had undergone their first test during pregnancy, which makes secondary cervical cancer prevention in prenatal care a useful prophylactic strategy. Special attention should be given to younger and professionally active women.

Association between antenatal classes attendance and perceived fear and pain during labour.

OBJECTIVES: Antenatal classes are a common method of preparation for birth with proven efficiency in improving perinatal outcomes. Yet, their impact on fear perception during labour has not been identified. The aim of the study was to analyse whether preparation for labour by means of antenatal classes attendance could be associated with decrease in level of experienced fear and pain during birth. MATERIALS AND METHODS: It was a cross-sectional study of 147 women who had given vaginal births. Data was collected from mothers between 24 and 72 h postpartum. Patients answered self-reported questionnaires concerning subjective perception of birth including Delivery Fear Scale (DFS) and Numeric Rating Scale (NRS) for fear and pain assessment. The study group was divided into subgroups depending on parity and antenatal classes attendance. RESULTS: Patients in the primiparas subgroup who attended antenatal classes scored lower in the DFS (48.7 ± 23.5 vs. 60.2 ± 16.5, p < .03). There was no difference in the DFS score in the multiparas subgroup (p < .90). No significant differences in the NRS score depending on antenatal classes attendance in any subgroup were observed. CONCLUSION: Participation in antenatal classes should be advised to every pregnant primiparous woman as this type of non-invasive preparation lowers level of fear experienced during childbirth.

Gestational diabetes mellitus (GDM) - do the number of fulfilled diagnostic criteria predict the perinatal outcome?

OBJECTIVES: The aim of the study was to check whether the number of fulfilled diagnostic criteria of gestational diabetes mellitus (GDM) had any association with patients' characteristics and pregnancy outcomes. MATERIAL AND METHODS: A total of 756 women with single pregnancies and GDM who gave birth at the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 01.2013-12.2016 were included in a retrospective analysis. Patients were divided into 2 groups: A - 499 patients diagnosed with GDM on the basis of one diagnostic criterion, B - 257 patients diagnosed with GDM on the basis of more than one diagnostic criterion. RESULTS: Patients from group A had lower pre-pregnancy BMI than those from group B (median 24.9 kg/m2 vs. 26.5 kg/m2, p=0.0003). Women from group A were less frequently treated with insulin than women from group B (19.1% vs. 32.7%; p=0.00002). Group A had lower median OGTT levels than group B (85.9 mg/dL vs. 94.1 mg/dL, p=0,0001; 160.2 mg/dL vs. 197.6 mg/dL, p=0.0001; 144.8 mg/dL vs. 167.0 mg/dL,p=0.0001; respectively). Moreover, in group B the average week of labor was earlier than in group A (mean 38,1 and 38,5 weeks of gestation, p=0,0006). CONCLUSIONS: Patients who fulfilled more than one diagnostic criterion for GDM may have worse pregnancy outcome. We think that a number of fulfilled diagnostic criteria for GDM may be an important risk factor for insulin therapy during pregnancy and earlier gestational age at delivery.