[Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers]. / Nadwaga i otyltosc--ogniwem laczacym cukrzyce ciazowa, makrosomie urodzeniowa i cukrzyce typu 2.

UNLABELLED: Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies and results in an increased incidence of Caesarean sections, perinatal traumas and neonatal complications. Macrosomy, i.e., an excessive birth-weight is observed in newborns from these pregnancies. In the majority of cases, diabetes regression is observed directly after pregnancy termination, however, in 15-60% of these patients, diabetes mellitus develops in later years of life. The goal of the study was an assessment of the risk factors for GDM development in gestation, perinatal macrosomy in offspring from GDM-affected pregnancies and overt diabetes mellitus in women after GDM. MATERIAL AND METHODS. The study involved 146 women with GDM and 1806 women with normal carbohydrate metabolism during pregnancy, 506 newborns of gestational diabetic mothers and 993 newborns of healthy mothers, as well as 200 women with a history of GDM during the years 1990-1999 (the mean time period after GDM - 3.1 +/- 6.0 years). The recognized risk factors of GDM and perinatal macrosomy were evaluated, together with the incidence of overt diabetes mellitus after GDM-affected pregnancy. RESULTS: An analysis of multifactor logistic regression demonstrated that the independent risk factors for GDM include: BMI 3 25 kg/m2 before pregnancy (OR - 2.38), the history of diabetes in family (OR - 1.67), and the third pr further pregnancy (OR - 1.81) - p < 0.05. In turn, experienced obstetric failures and delivery of child with macrosomy features revealed insignificant - p > 0.05. Perinatal macrosomy correlated with mother's BMI and glycaemia during the 2nd hour of diagnostic test (75 g OGTT). No correlations were observed among mother's age, fasting glycaemia levels and HbA1c in mothers. In the group of GDM-affected women, diabetes mellitus type 2 was diagnosed in 34 (17.0%) patients. The the actual BMI > 25 kg/m2 and glycaemia values in the 2nd hour of diagnostic test in the course of GDM diagnosis (p < 0.05). The risk of diabetes was not enhanced in that group of women by family history of diabetes, the age of GDM onset (< 25 years of life), the week of gestation when GDM was diagnosed (< 25 hbd), and the type of GDM therapy (insulin vs. diet) p > 0.05 CONCLUSIONS: Overweight and obesity are both risk factors of gestational diabetes mellitus, delivery of child with macrosomy features and of overt diabetes mellitus later in life.

Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups.

OBJECTIVES: We examined associations between obesity, diabetes, and 3 adverse pregnancy outcomes--primary cesarean delivery, preterm birth, and low birth-weight (LBW)--by racial/ethnic group. Our goal was to better understand how these associations differentially impact birth outcomes by group in order to develop more focused interventions. METHODS: Data were collected from the 1999, 2000, and 2001 New York City birth files for 329,988 singleton births containing information on prepregnancy weight and prenatal weight gain. Separate logistic regressions for 4 racial/ethnic groups predicted the adverse pregnancy outcomes associated with diabetes. Other variables in the regressions included obesity, excess weight gain, hypertension, preeclampsia, and substance use during pregnancy (e.g., smoking). RESULTS: Chronic and gestational diabetes were significant risks for a primary cesarean and for preterm birth in all women. Diabetes as a risk for LBW varied by group. For example, whereas chronic diabetes increased the risk for LBW among Asians, Hispanics, and Whites (adjusted odds ratios=2.28, 1.69, and 1.59), respectively, it was not a significant predictor of LBW among Blacks. CONCLUSIONS: In this large, population-based study, obesity and diabetes were independently associated with adverse pregnancy outcomes, highlighting the need for women to undergo lifestyle changes to help them control their weight during the childbearing years and beyond.

[Gestational diabetes: an update]. / Le diabète gestationnel.

Gestational diabetes mellitus is one of the major medical complications of pregnancy. This review describes the short and long term consequences of this affection, the screening strategy and the diagnosis approach. The obstetrical management and the diabetes treatment with dietary strategies reducing carbohydrate intake and minimising the postprandial glucose levels are explained. Insulin treatment indication, place of insulin analogues, and use of oral antihyperglycaemic agents are also discussed.

Diagnostic controversy: gestational diabetes and the meaning of risk for pima Indian women.

Gestational diabetes is the one form of this well known, chronic disease of development that disappears. After the birth of the child, the mother's glucose levels typically return to normal. As a harbinger of things to come, gestational diabetes conveys greater risk for later type 2 (previously "non-insulin dependent") diabetes in both the mother and child. Thus, pregnant women have become a central target for prevention of this disease in the entire Pima population. Based on ethnographic interviews conducted between 1999 and 2000, I discuss the negotiated meanings of risk, "borderline" diabetes, and women's personal knowledge and experiences of diabetes, particularly during the highly surveilled period of pregnancy. I also highlight the heterogeneity of professional discourse pertaining to gestational diabetes, most notably the debate surrounding its diagnosis. Significantly, women's narratives reveal the same set of questions as is raised in the professional debate. Implications for diabetes prevention and for balancing the increased surveillance of pregnant women with clinical strategies that privilege their experience and perspectives are also discussed.

[Analysis of risk factors for perinatal brachial plexus palsy]. / Analiza czynników ryzyka okoloporodowych uszkodzen splotu ramiennego.

OBJECTIVES AND DESIGN: Risk factors of obstetrical brachial plexus palsy include: (1) large birth weight, (2) shoulder dystocia and prolonged second stage of labour, (3) instrumental vaginal delivery (forceps delivery, vacuum extraction), (4) diabetes mellitus and mother's obesity, (5) breech presentation, (6) delivery and infant with obstetrical brachial plexus palsy in antecedent delivery. The purpose was analysis of the classical risk factors for brachial plexus palsy based on our own clinical material. MATERIAL AND METHODS: Clinical material consists of 83 children with obstetrical brachial plexus palsy treated at the Department of Trauma and Hand Surgery (surgically--54, conservatively--29). Control group consists of 56 healthy newborns. Data recorded included: birth weight, body length, head and chest circumference, Apgar test at 1 min., type of brachial palsy and side affected, type of birth, presentation, duration of delivery (II stage), age of mother, mother's diseases, parity. RESULTS: The infants treated surgically have had a significantly higher birth weight, body height, head and chest circumference, in compression with control group and group treated conservatively. The differences were statistically important. Shoulder dystocia occurred in 32.9% of all vaginal delivery. Instrumental vaginal delivery was observed in 11.3% and breech presentation in 4.9% cases. There were no incidences of obstetrical brachial plexus palsy recurrence. Diabetes mellitus and mother's obesity was found in 3 cases. CONCLUSIONS: (1) Fetal macrosomia is the important risk factor of the obstetrical brachial plexus palsy. (2) Obstetrical brachial plexus palsy may occur also in the absence of the classical risk factors.

Metabolic and vascular abnormalities in subjects at risk for type 2 diabetes: the early start of a dangerous situation.

Various groups at risk for type 2 diabetes have been identified, including individuals with family history of type 2 diabetes, obesity, prior gestational diabetes, polycystic ovary syndrome, metabolic syndrome, hypertension, dyslipidemia and particularly those with pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose). To various degrees, all these groups have also been identified with significant vascular abnormalities that range from endothelial dysfunction and low-grade or sub-clinical inflammation to evident atherosclerosis. The mechanisms involved in establishing a link between the risk of type 2 diabetes and vascular dysfunction are multiple and complex. The presence in the circulation of various cytokines, hormones and substrates associated with increased visceral fat and insulin resistance, the frequent appearance of associated cardiovascular risk factors and/or the possibility of some genetically determined intrinsic vascular abnormalities are all explanatory mechanisms that are being evaluated in clinical research. Whereas the possibility of appreciating a significant reduction in cardiovascular outcomes in long-term prospective clinical trials in all these groups at risk for type 2 diabetes is still lacking, understanding these mechanisms and recognizing how various interventions may improve vascular health is a worthwhile area of research that may translate into important clinical strategies to reduce the burden of type 2 diabetes and cardiovascular disease.

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

BACKGROUND: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. METHODS: We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. RESULTS: The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. CONCLUSIONS: Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.

Screening for gestational diabetes mellitus.

The term 'gestational diabetes mellitus' is unsatisfactory as it refers to a heterogeneous group of women, including those with minimal abnormality of carbohydrate metabolism and those with undiagnosed type II diabetes. However, perinatal morbidity is increased even in the group of women who have only impaired glucose tolerance; the mothers are at increased risk of subsequent development of diabetes, and there may also be long-term implications for the offspring. Current research is aiming to define the blood glucose levels at which risks increase so that clinical management can be appropriately directed. When available, the criteria required to justify population screening in pregnancy should be satisfied. The glucose challenge and fasting glucose tests are the leading contenders as appropriate screening tests to determine who should have the diagnostic glucose tolerance test. However, until this is reviewed, the widely used scheme of risk factors as a screening method should continue, as it detects at least 50% of women with gestational diabetes.

Controversies around gestational diabetes. Practical information for family doctors.

OBJECTIVE: To summarize some of the issues facing primary care physicians who are seeing increasing numbers of patients with gestational diabetes mellitus (GDM) and to explore new developments in use of oral hypoglycemics during pregnancy. QUALITY OF EVIDENCE: All the literature on screening for GDM offers level III evidence. Much of the literature on treatment is also level III, but newer studies offer level I evidence and are more useful for daily practice. Existing research leaves many important questions unanswered; research findings are inconsistent among studies, and treatment strategies are challenging to implement. MAIN MESSAGE: Recent studies have clarified that rates of neonatal mortality and congenital malformations are not higher among the offspring of mothers with GDM. Treatment might affect birth weight, but whether treatment is associated with reductions in rates of shoulder dystocia and cesarean section is unclear. Several level I studies conclude that the oral hypoglycemic glyburide can be used safely and effectively during the second and third trimesters of pregnancy. CONCLUSION: Management of GDM remains a controversial area in obstetric care. It is a growing area of research, and new developments that might clarify risk and simplify treatment are expected in the coming years.

Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers.

AIM: To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. METHODS: Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Student's t tests. RESULTS: The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. CONCLUSION: The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs.

[Risks factors for the development of diabetes in women with history of gestational diabetes mellitus]. / Czynniki ryzyka zaburzen gospodarki weglowodanowej u kobiet po przebytej cukrzycy ciezarnych.

UNLABELLED: Women who suffered from impaired carbohydrate metabolism during pregnancy are more likely to develop different types of diabetes later in their lives. The aim of this paper was to study the risk factors for the development of diabetes in group of women with gestational diabetes mellitus (GDM) in anamnesis. MATERIALS AND METHODS: 200 women took part in this study, who had gestational diabetes diagnosed between 1980-1998. All women were divided into 4 groups depending on the type of disorders occurring at the moment of examination: DM1 - women diagnosed with type I diabetes, DM2 - women diagnosed with type 2 diabetes, IGT-women with glucose levels in OGTT, which applied to impaired glucose tolerance (acc. to WHO criteria), NDM - women with no clinical signs of diabetes, with normal result of OGTT. RESULTS: The risk of diabetes development is significantly higher (independently of the clinical type) in women who had had GDM include: high glucose levels at the time of GDM diagnosis, early onset of symptoms - related to weeks of gestation, and the insulin treatment during pregnancy. However multifactor analysis indicates that the only significant risk factors for DM 1 are early onset of diabetes during pregnancy and high glucose levels 2 hours after OGTT during pregnancy (p < 0.05). High levels of glucose 2 hours after OGTT and high Body Mass Index (BMI) turned out to be the independent risk factors of diabetes type 2 (p < 0.05). CONCLUSIONS: Knowledge of risk factors allows to recognize a diabetes high risk group among women who suffered from diabetes during pregnancy.

Subclinical inflammation and vascular dysfunction in women with previous gestational diabetes mellitus.

CONTEXT: A history of gestational diabetes (GDM) significantly increases the risk of developing type 2 diabetes, an independent risk factor for cardiovascular disease (CVD). It is not known whether nondiabetic women with prior GDM are also at increased risk of CVD. OBJECTIVE: The aim of this study was to compare biochemical and hemodynamic surrogate markers of CVD in nondiabetic women with and without a history of GDM who were at least 1 yr post delivery. DESIGN: This was a single center cross-sectional study. SETTING: The study was performed in an academic referral center. SUBJECTS: Forty-eight premenopausal healthy women with a history of GDM (n = 25) or a history of normal pregnancy (n = 23) were studied in the follicular phase of the menstrual cycle. MAIN OUTCOME MEASURES: The main outcome measures were: 1) inflammatory markers associated with CVD including C-reactive protein, IL-6, and plasminogen activator inhibitor-1; 2) the adipokine adiponectin; and 3) conduit vessel stiffness. RESULTS: When compared to normal controls, women with prior GDM had higher mean levels of C-reactive protein (3.58 +/- 3.86 vs. 0.52 +/- 0.16 mg/liter; P < 0.001), IL-6 (1.81 +/- 1.04 vs. 0.99 +/- 0.52 pg/ml; P = 0.001), plasminogen activator inhibitor-1 (29.6 +/- 17.6 vs. 16.5 +/- 14.0 ng/ml; P = 0.001), and lower levels of adiponectin (8.9 +/- 3.9 vs. 15.9 +/- 7.3 microg/ml; P = 0.001). Women with prior GDM also had significantly (P

The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population.

CONTEXT: Diabetes and obesity, components of the metabolic syndrome, are common characteristics of women with prior gestational diabetes mellitus (GDM). Due to increasing incidence of diabetes and obesity, the metabolic syndrome might comprise a major health problem among these women. OBJECTIVE: The objective was to estimate the prevalence of the metabolic syndrome by three different criteria [World Health Organization 1999 (WHO), The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 2001, and European Group for the Study of Insulin Resistance 2002] among women with previous GDM. DESIGN: We conducted a follow-up study of a Danish cohort of women admitted in 1978-1996 to the Diabetes and Pregnancy Center, Rigshospitalet, Copenhagen University Hospital, with diet-treated GDM. The follow-up took place in 2000-2002 at median 9.8 yr (interquartile range 6.4-17.2) after pregnancy. Results were compared with a control group of 1000 age-matched women from a population-based sample (Inter99). PARTICIPANTS: Four hundred eighty-one women at median age 43 yr (interquartile range 38-48) participated. MAIN OUTCOME MEASURES: The main outcome measures were body mass index (BMI), glucose tolerance, blood pressure, lipid profile, and insulin resistance. RESULTS: Independent of the criteria, the prevalence of the metabolic syndrome was three times higher in the prior GDM group, compared with the control group (e.g. WHO: 38.4 vs. 13.4%, P < 0.0005). Age- and BMI-adjusted odds ratio for having the WHO-defined metabolic syndrome was 3.4 (95% confidence interval 2.5-4.8) for the prior GDM group vs. the control group. Obese women (BMI > 30 kg/m(2)) with previous GDM had a more than 7-fold increased prevalence of the metabolic syndrome (WHO), compared with normal-weight prior GDM women (BMI < 25 kg/m(2)). In glucose-tolerant women, the prevalence was doubled in the prior GDM group, compared with control group. CONCLUSION: The prevalence of the metabolic syndrome was three times as high in women with prior diet-treated GDM, compared with age-matched control subjects.

Are plasma total homocysteine and other amino acids associated with glucose intolerance in uncomplicated pregnancies and preeclampsia?

OBJECTIVE: To evaluate the possible association between plasma total homocysteine or other amino acid concentrations and gestational diabetes or glucose intolerance (GI), in normotensive and preeclamptic pregnant women. STUDY DESIGN: Prospective study including 243 pregnant women without previous risk factors. O'Sullivan test (plus oral glucose tolerance test when necessary) was performed, and homocysteine, B vitamins and plasma amino acids (AA) were measured at 24-25 weeks. Homocysteine and other amino acids were also measured in the third trimester. RESULTS: Significant differences were observed in the incidence of preeclampsia in relation to abnormal glucose tolerance (P < 0.012). In normotensive patients, the glucose intolerance group showed significantly lower tHcy (P = 0.021) and increased plasma alanine concentrations in comparison with controls (P = 0.046), although no correlation was observed between both amino acid concentrations. CONCLUSIONS: (a) A higher incidence of preeclampsia was observed in abnormal glucose tolerance patients, (b) total homocysteine and alanine were the only individual amino acids whose plasma concentrations varied according to the glucose tolerance classes, and (c) an association between hyperhomocysteinemia and glucose intolerance in our preeclamptic patients could not be demonstrated.

Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus.

OBJECTIVE: Childhood obesity has contributed to an increased incidence of type 2 diabetes mellitus and metabolic syndrome (MS) among children. Intrauterine exposure to diabetes and size at birth are risk factors for type 2 diabetes mellitus, but their association with MS in childhood has not been demonstrated. We examined the development of MS among large-for-gestational-age (LGA) and appropriate-for-gestational age (AGA) children. STUDY DESIGN: The major components of MS (obesity, hypertension, dyslipidemia, and glucose intolerance) were evaluated in a longitudinal cohort study of children at age 6, 7, 9, and 11 years who were LGA (n = 84) or AGA (n = 95) offspring of mothers with or without gestational diabetes mellitus (GDM). The cohort consisted of 4 groups, ie, LGA offspring of control mothers, LGA offspring of mothers with GDM, AGA offspring of control mothers, and AGA offspring of mothers with GDM. Biometric and anthropometric measurements were obtained at 6, 7, 9, and 11 years. Biochemical testing included measurements of postprandial glucose and insulin levels and high-density lipoprotein (HDL) cholesterol levels at 6 and 7 years and of fasting glucose, insulin, triglyceride, and HDL cholesterol levels at 9 and 11 years. We defined the components of MS as (1) obesity (BMI >85th percentile for age), (2) diastolic or systolic blood pressure >95th percentile for age, (3) postprandial glucose level >140 mg/dL or fasting glucose level >110 mg/dL, (4) triglyceride level >95th percentile for age, and (5) HDL level <5th percentile for age. RESULTS: There were no differences in baseline characteristics (gender, race, socioeconomic status, and maternal weight gain during pregnancy) for the 4 groups except for birth weight, but there was a trend toward a higher prevalence of maternal obesity before pregnancy in the LGA/GDM group. Obesity (BMI >85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring. There was a trend toward a higher incidence of insulin resistance, defined as a fasting glucose/insulin ratio of <7, in the LGA/GDM group at 11 years. Analysis of insulin resistance at 11 years in a multivariate logistic regression revealed that childhood obesity and the combination of LGA status and maternal GDM were associated with insulin resistance, with odds ratios of 4.3 (95% confidence interval [CI]: 1.5-11.9) and 10.4 (95% CI: 1.5-74.4), respectively. The prevalence at any time of > or =2 components of MS was 50% for the LGA/GDM group, which was significantly higher than values for the LGA/control group (29%), AGA/GDM group (21%), and AGA/control group (18%). The prevalence of > or =3 components of MS at age 11 was 15% for the LGA/GDM group, compared with 3.0% to 5.3% for the other groups. Cox regression analysis was performed to determine the independent hazard (risk) of developing MS attributable to birth weight, gender, maternal prepregnancy obesity, and GDM. For Cox analyses, we defined MS as > or =2 of the following 4 components: obesity, hypertension (systolic or diastolic), glucose intolerance, and dyslipidemia (elevated triglyceride levels or low HDL levels). LGA status and maternal obesity increased the risk of MS approximately twofold, with hazard ratios of 2.19 (95% CI: 1.25-3.82) and 1.81 (95% CI: 1.03-3.19), respectively. GDM and gender were not independently significant. To determine the cumulative hazard of developing MS with time, we plotted the risk according to LGA or AGA category for the control and GDM groups from 6 years to 11 years, with Cox regression analyses. The risk of developing MS with time was not significantly different between LGA and AGA offspring in the control group but was significantly different between LGA and AGA offspring in the GDM group, with a 3.6-fold greater risk among LGA children by 11 years. CONCLUSIONS: We showed that LGA offspring of diabetic mothers were at significant risk of developing MS in childhood. The prevalence of MS in the other groups was similar to the prevalence (4.8%) among white adolescents in the 1988-1994 National Health and Nutrition Examination Survey. This effect of LGA with maternal GDM on childhood MS was previously demonstrated for Pima Indian children but not the general population. We also found that children exposed to maternal obesity were at increased risk of developing MS, which suggests that obese mothers who do not fulfill the clinical criteria for GDM may still have metabolic factors that affect fetal growth and postnatal outcomes. Children who are LGA at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing MS. Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.

Infant outcomes of gestational diabetes mellitus.

This study was carried out in Mymensingh Medical College and Hospital, Mymensingh. The work, which lasted for one year commencing in July 2003, was designed to find out and compare the infant outcomes of gestational diabetes mellitus (GDM) with a view to reducing the complications. Forty cases of GDM with single pregnancy were selected as experimental group, while forty other cases of pregnant women without GDM constituted the control group. Questionnaire and observation charts were the research instruments. Statistical analyses were done manually. It was retrieved that the offspring of GDM mothers had a higher risk of macrosomia, neonatal jaundice and respiratory complications. The perinatal mortality rate was also more in GDM cases. However, befitting measures for prevention, treatment and management of GDM may be taken up to ameliorate the situation.

Megalourethra: A report of three cases associated with maternal diabetes and a review of the literature--is sonic hedgehog the common pathway?

The mechanisms by which maternal diabetes causes malformations in the offspring have yet to be elucidated. The purpose of this report is twofold: first, to describe three male infants born with multiple congenital anomalies and megalourethra, a defect which has not been previously reported in infants of women with diabetes; and second, to indicate that the defects seen in association with megalourethra in these three infants are similar to those seen as a consequence of abnormalities in sonic hedgehog, suggesting that maternal diabetes may affect sonic hedgehog expression in susceptible tissues during critical stages of development.

Resultados perinatales preliminares de diabetes gestacional en el Hospital Barros Luco Trudeau / Preliminary perinatal results of gestational diabetes at the Barros Luco Trudeau Hospital

La diabetes gestacional es la alteración del metabolismo de los hidratos de carbono, que se inicia o pesquisa por primera vez durante el embarazo. El diagnóstico se realiza mediante una prueba de tolerancia a la glucosa o dos glicemias de ayuno alteradas. El objetivo de esta revisión es dar a conocer la primera etapa de un trabajo a largo plazo, sobre los resultados perinatales de estas embarazadas controladas en la Unidad de Medicina Materno-Fetal del Hospital Barros Luco Trudeau. Se revisaron 163 fichas clínicas de pacientes atendidas durante el primer semestre del 2001. El criterio de inclusión empleado fue prueba de tolerancia a la glucosa > 140 mg/dl a las 2 horas post carga con 75 gramos de glucosa en embarazadas con más de 20 semanas de gestación, establecido según las Normas del Ministerio de Salud. Se recopilaron datos perinatales de la embarazada y del neonato, tales como factores de riesgo de diabetes gestacional, estado nutricional al ingreso y egreso a los controles, patología obstétrica asociada, vía del parto, complicaciones y patologías neonatales, entre otras. La mayor proporción de las pacientes tienen entre 18 y 34 años. El antecedente de diabetes mellitus familiar fue encontrado en un tercio de la muestra. El 24,58 por ciento y el 59,51 por ciento de las pacientes ingresó y egresó a los controles obesa respectivamente, representando esto un aumento en esta patología post parto. La patología concomitante más frecuente fue el síndrome hipertensivo del embarazo (20,8 por ciento). Los prematuros correspondieron al 8,59 por ciento. Las cesáreas fueron 37,4 por ciento. La macrosomía se encontró en un 9,8 por ciento de los neonatos. La complicación neonatal más frecuente fue la hiperbilirrubinemia (12,88 por ciento). Se destaca la prevalencia de obesidad en estas pacientes, el antecedente de diabetes mellitus en familiares de primer grado y el buen resultado perinatal obstétrico.