Hyperglycemia in pregnancy - prevalence and perinatal outcomes. A retrospective multicenter cohort study in Poland.

OBJECTIVES: Hyperglycemia in pregnancy (HIP) is one of the most common complications of pregnancy. Recently adopted new criteria for the diagnosis of HIP as well as the greater prevalence of risk factors could have a significant impact on HIP prevalence. The objective of the study was to assess the rates of HIP and the associated complications. MATERIAL AND METHODS: This was a retrospective analysis of clinical records from pregnant women who delivered in eight tertiary hospitals in Poland in 2016. RESULTS: The number of pregnant women with hyperglycemia totaled 1280 (7.25%), including gestational diabetes mellitus (GDM) in 1169 (6.62%) women and pregestational diabetes mellitus (PGDM) in 111 (0.63%). In addition to dietary modifications, 477 (41% of the GDM group) women received medical treatment (GDMG2). In women with PGDM multiple daily insulin injections (MDI) were used in 53 (47.7%) cases, continuous subcutaneous insulin infusions (CSII) in 57 (51.3%) cases and one woman was treated with metformin. The rate of cesarean sections was 69.4% and 62.9% for PGDM and GDM, respectively. Large-for-gestational-age (LGA) infants accounted for 38% and 21% of births in the PGDM and GDM groups, respectively. Of note are high rates of hyperbilirubinemia in infants born to mothers treated with insulin (13.5% for PGDM and 14.4% for GDMG2) vs infants born to mothers with diet (GDMG1) (3.4%). CONCLUSIONS: In Poland, the prevalence of HIP has nearly doubled in the past twenty years. Even with appropriate management, HIP is a significant risk factor for a cesarean section delivery, bearing an LGA infant and adverse neonatal outcomes.

Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis.

OBJECTIVES: Intrahepatic cholestasis of pregnancy (ICP) is a liver specific disorder affecting 0.08%-27.6% pregnant women.It is characterized by reduced expression of the primary bile acid farnesoid receptor (FXR). In recent studies, it has beenshowed that FXR has an impact on normal glucose homeostasis. Based on that it was suggested that the level of bile acidscorrelates with glucose level. The aim of the study was to evaluate the association between ICP and gestational diabetesmellitus (GDM). MATERIAL AND METHODS: 102 singleton patients complicated by ICP were included to the study and divided into twogroups: non-GDM group (74 patients) and GDM group (28 patients). ICP was diagnosed based on the serum bile acidslevel > 10 µmol/L and GDM with the 75 g oral glucose tolerance test and FIGO guidelines. Demographic and clinical outcomedata (including maternal age, BMI and infant weight) and ICP and GDM biochemical markers were collected. RESULTS: The incidence of GDM in ICP patients was 27.45%. 73% of women included to the study developed mild cholestasis.Lower levels of serum bile acids were correlated with GDM group. When compared mean total bilirubin level wassignificantly higher in non-GDM group. Transaminases (ALT, AST) and neonate condition including mean birth weightrevealed no significant difference between the groups. On the other hand, prevalence of large for gestational age wassignificantly higher in non-GDM group (p < 0.00001). CONCLUSIONS: The incidence of ICP is higher in women with GDM.

Birth after a previous cesarean section - what is most important in making a decision?

OBJECTIVE: A retrospective analysis of the course of labour in patients after one caesarean section (CS) and of factors influencing successful attempt of vaginal birth after caesarean (VBAC). DESIGN: A group of 296 patients after one CS was divided into: group G1 (206 patients) - elective CS, group G2 (90) - VBAC attempt, and G2 to: G2a (35) - VBAC and G2b (55) - CS after an unsuccessful VB attempt. A comparative analysis between the groups and logistic regression analysis of factors influencing a successful VBAC was made. RESULTS: There were no differences regarding age, BMI, weight gain during pregnancy or gestational age between groups G1 and G2, as well as G2a and G2b. G2a patients had more often already given VB previously (28.6% vs 10.9%; p=0.03). The most frequent indication for a repeat elective CS was the lack of informed consent for VBAC (29.13% of all indications). The mean neonatal birthweight was highest in G1 (3 410 g), and in G2b higher than in G2a (3 275 g vs 3 098 g; p=0.009). There were no differences in newborns' general condition between the group. There were no cases of uterine rupture and 4 cases of uterine scar dehiscence in G1 and 1 in G2. Of all the analysed factors only spontaneous delivery onset (OR 7.78) and previous vaginal birth after the caesarean (OR 1.99) or before the caesarean (OR 2.03) had significant influence on successful VBAC trial. CONCLUSION: The right classification of patients is a significant factor having effect on the success of a VB attempt after CS.