Serum lipid levels in relation to clinical outcomes in pregnant women with gestational diabetes mellitus: an observational cohort study.

BACKGROUND: Research on dyslipidemia during pregnancy in women with gestational diabetes mellitus (GDM) has rarely been conducted in Asia. The present study aimed to evaluate maternal mid-trimester lipid profile in relation to GDM and clinical outcomes in these high-risk populations. METHODS: The medical records of 632 pregnant women in the second trimester were retrospectively analyzed. Maternal fasting serum lipids were assayed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A1 (Apo A1) and Apo B concentrations during the second trimester. The atherogenic index of plasma (AIP) was calculated as log (TG/HDL). The clinical outcomes were collected by evaluating delivery mode, postpartum hemorrhage, prematurity, macrosomia, birth weight, body length and neonatal Apgar 5 min score. RESULTS: Levels of TG and AIP were elevated while decreased HDL-C was observed in women with GDM compared with that of the control group. Significant differences were observed in gestational weeks at birth, cesarean section, postpartum hemorrhage, birth weight, body length, prematurity and macrosomia between the two groups. Compared with women with hyperlipidemia, the incidence of GDM and cesarean section was lower in normal lipid group. Women in the hyperlipidemia group had smaller gestational weeks at birth than those in the control group. According to the logistic regression analysis, each unit elevation in AIP increased the risk of GDM by 18.48 times (OR = 18.48, CI: 2.38-143.22). Besides, age (OR = 1.11, CI: 1.06-1.16) and pre-pregnancy BMI (OR = 1.15, CI: 1.07-1.24) were the risk factors of GDM. CONCLUSIONS: These findings suggested that reasonable lipid control in the second trimester might reduce the incidence of GDM and be a potential strategy for improving clinical outcomes in these high-risk women.

Characteristics of gestational diabetes subtypes classified by oral glucose tolerance test values.

BACKGROUND: In clinical practice, gestational diabetes mellitus (GDM) is treated as a homogenous disease but emerging evidence suggests that the diagnosis of GDM possibly comprises different metabolic entities. In this study, we aimed to assess early pregnancy characteristics of gestational diabetes mellitus entities classified according to the presence of fasting and/or post-load hyperglycaemia in the diagnostic oral glucose tolerance test performed at mid-gestation. METHODS: In this prospective cohort study, 1087 pregnant women received a broad risk evaluation and laboratory examination at early gestation and were later classified as normal glucose tolerant (NGT), as having isolated fasting hyperglycaemia (GDM-IFH), isolated post-load hyperglycaemia (GDM-IPH) or combined hyperglycaemia (GDM-CH) according to oral glucose tolerance test results. Participants were followed up until delivery to assess data on pharmacotherapy and pregnancy outcomes. RESULTS: Women affected by elevated fasting and post-load glucose concentrations (GDM-CH) showed adverse metabolic profiles already at beginning of pregnancy including a higher degree of insulin resistance as compared to women with normal glucose tolerance and those with isolated defects (especially GDM-IPH). The GDM-IPH subgroup had lower body mass index at early gestation and required glucose-lowering medications less often (28.9%) as compared to GDM-IFH (47.8%, P = .019) and GDM-CH (54.5%, P = .005). No differences were observed in pregnancy outcome data. CONCLUSIONS: Women with fasting hyperglycaemia, especially those with combined hyperglycaemia, showed an unfavourable metabolic phenotype already at early gestation. Therefore, categorization based on abnormal oral glucose tolerance test values provides a practicable basis for clinical risk stratification.

Effects of Changing Diagnostic Criteria for Gestational Diabetes Mellitus in Queensland, Australia.

OBJECTIVE: To evaluate the effects of updated gestational diabetes mellitus (GDM) screening and diagnostic criteria on selected perinatal outcomes in Queensland, Australia. METHODS: This was a pre-post comparison study using perinatal data the year before (2014) and after (2016) the screening and diagnostic criteria for GDM was changed in Queensland, Australia. In 2015, Queensland adopted the one-step screening and diagnostic criteria based on the International Association of the Diabetes and Pregnancy Study Groups' recommendations. The data from 62,517 women in 2014 and 61,600 women in 2016 who gave birth from 24 weeks of gestation were analyzed in three groups in each year: women with GDM; women without diagnosed GDM; and total population. The outcome measures were gestational hypertension, cesarean birth, gestational age at delivery, birth weight, preterm delivery, large-for-gestational age (LGA) neonates, small-for-gestational-age (SGA) neonates, neonatal hypoglycemia, and respiratory distress. RESULTS: The diagnosis of GDM increased from 8.7% (n=5,462) to 11.9% (n=7,317). After changing the diagnostic criteria, the changes to outcomes, odds ratios (OR), and adjusted odds ratios (aOR) (95% CI) for outcomes with statistically significant differences for the total population were: gestational hypertension 4.6% vs 5.0%, OR 1.09 (1.03-1.15), aOR 1.07 (1.02-1.13); preterm birth 7.6% vs 8.0%, OR 1.05 (1.01-1.09), aOR 1.06 (1.02-1.10); neonatal hypoglycemia 5.3% vs 6.8%, OR 1.31 (1.25-1.37), aOR 1.32 (1.25-1.38); and respiratory distress 6.2% vs 6.0%, OR 0.96 (0.91-1.00), aOR 0.94 (0.89-0.99). There was no change to cesarean births or LGA or SGA neonates for women with or without diagnosed GDM or the total population. CONCLUSION: Except for a very small decrease in respiratory distress, changing the diagnostic criteria has resulted in more GDM diagnoses with no observed changes to measured perinatal outcomes for women with and without diagnosed GDM.

Caracterización clínica de la diabetes gestacional en el Policlínico Ignacio Agramonte de 2011-2015 / Clinical characterization of the gestational diabetes in Ignacio Agramonte clinic from 2011 to 2015

Fundamento: la diabetes gestacional se define como la intolerancia a los hidratos de carbono de intensidad variable, de comienzo durante la gestación, con independencia de que la diabetes continúe después del parto.Objetivo: caracterizar la diabetes gestacional durante un quinquenio.Métodos: se realizó un estudio descriptivo transversal, al universo de gestantes diagnosticadas de diabetes gestacional pertenecientes al área de salud del Policlínico Ignacio Agramonte en la provincia de Camagüey durante los años 2011 al 2015, incluidas todas las que dieron su consentimiento informado para participar, excluidas las diagnosticadas antes de esa etapa y las diabetes mellitus de otra clasificación. Se creó una base de datos en Excel y luego se exportó al SPSS 12 (SPSS, Chicago, IL) sobre Windows XP. Se aplicó estadística descriptiva.Resultados: al inicio de la gestación cerca de la mitad estaban normo peso, la ganancia de peso fue más la exagerada en las normo peso, los recién nacidos macro fetos se presentaron sobre todo en las obesas. Como enfermedad clínica asociada se destacó la infección vaginal, y en antecedentes obstétricos los abortos espontáneos. Antecedente familiar de madre con diabetes mellitus y una malformación congénita. La mayoría de las madres al nacer no fueron macro fetos.Conclusiones: los macro fetos se presentaron sobre todo en las obesas, hubo antecedentes de aborto espontáneo y no se destacó la presencia de malformaciones congénitas(AU)

Background: the gestational diabetes is defined as the intolerance to the hydrates of carbon of variable intensity, beginning during gestation, despite that the diabetes continues after the childbirth.Objective: to characterize the gestational diabetes during a five-year period.Method: a transversal descriptive study was conducted with the universe of pregnant women diagnosed with gestational diabetes belonging to the health area Ignacio Agramonte from 2011 to 2015, including all who wanted to participate, and excluded those diagnosed before that stage and the diabetes mellitus of another classification. A database in Excel was created and then it was exported to the SPSS 12 (SPSS, Chicago, IL). Descriptive statistic was applied. Results: at the beginning of the gestation nearly half of them were normo weight, the gaining of weight was the most exaggerated one in the normo weight, the recently born macro fetuses was presented mostly in obese. As associate clinical pathology vaginal sepsis stood out and in obstetric backgrounds the spontaneous abortions: the family background of diabetes mellitus in the mother and a single congenital malformation. Most of the mothers when being born were not macro fetuses.Conclusions: the macro fetuses were presented mostly in obese, there were antecedents of spontaneous abortion and the presence of congenital malformations did not stand out(AU)

Gestational Diabetes: Diagnosis, Classification, and Clinical Care.

Gestational diabetes mellitus (GDM) affects approximately 6% of pregnant women, and prevalence is increasing in parallel with the obesity epidemic. Protocols for screening/diagnosing GDM are controversial with several guidelines available. Treatment of GDM results in a reduction in the incidence of preeclampsia, shoulder dystocia, and macrosomia. If diet and lifestyle changes do not result in target glucose levels, then treatment with metformin, glyburide, or insulin should begin. It is generally recommended that pregnancies complicated by GDM do not go beyond term. For women identified to have prediabetes, intensive lifestyle intervention and metformin have been shown to prevent or delay progression to type 2 diabetes.

Fulminant Type 1 Diabetes Mellitus Presenting 11 Days after Delivery in a Patient of Mixed Genetic Background.

The patient was a 25-year-old woman whose paternal family was Japanese, maternal grandfather was Filipino, and maternal grandmother was Chinese. Eleven days after delivery, she presented with excessive thirst and disturbed consciousness due to diabetic ketoacidosis. She was diagnosed as having fulminant type 1 diabetes associated with pregnancy (PF). The antibody concentration against glutamic acid decarboxylase was 1.2 (<1.5) U/mL, and human leukocyte antigen (HLA) class II haplotypes were DRB1*04:10-DQB1*03:02 and DRB1*15:02-DQB1*05:01. The present case had unique HLA class II haplotypes that have not been previously reported in association with PF.

Pregnancy Outcomes in Women with 1-Hour Glucose Challenge Test ≥ 200 mg/dL.

OBJECTIVE: Many protocols diagnose gestational diabetes mellitus (GDM) solely on a 1-hour glucose challenge test (GCT) ≥ 200 mg/dL. However, pregnancy outcomes in these women compared with women diagnosed with a 3-hour glucose tolerance test (GTT) has not been adequately evaluated. We hypothesize that a 1-hour GCT ≥ 200 mg/dL is associated with worse pregnancy outcomes as compared with a GCT 135 to 199 mg/dL with positive GTT. STUDY DESIGN: A retrospective cohort of singleton pregnancies complicated by GDM. Maternal outcomes included A2DM, preeclampsia, primary cesarean, and failed trial of labor after cesarean. Perinatal outcomes were large/small for gestational age, shoulder dystocia, and birth injury. Groups were compared with t-test and chi-square test, and logistic regression to adjust for confounders. RESULTS: A total of 602 women diagnosed with GDM by 1-hour GCT 135 to 199 mg/dL and confirmatory 3-hour GTT (< 200 group) and 225 women diagnosed with 1-hour GCT ≥ 200 alone (≥ 200) were included. The ≥ 200 group had a higher incidence of preeclampsia (16.4 vs. 10.6%) and shoulder dystocia (3.1 vs. 1.0%). Adjusted odds ratio and 95% confidence interval were 1.80 (1.10-2.94) and 5.10 (1.25-20.76), respectively. CONCLUSION: Preeclampsia and shoulder dystocia are more frequent in women with GCT ≥ 200 mg/dL than those with a positive GTT following a GCT of 135 to 199 mg/dL.

Transcriptome meta-analysis of peripheral lymphomononuclear cells indicates that gestational diabetes is closer to type 1 diabetes than to type 2 diabetes mellitus.

We performed a meta-analysis of the transcription profiles of type 1, type 2 and gestational diabetes to evaluate similarities and dissimilarities among these diabetes types. cRNA samples obtained from peripheral blood lymphomononuclear cells (PBMC) of 56 diabetes mellitus patients (type 1 = 19; type 2 = 20; gestational = 17) were hybridized to the same whole human genome oligomicroarray platform, encompassing 44,000 transcripts. The GeneSpring software was used to perform analysis and hierarchical clustering, and the DAVID database was used for gene ontology. The gene expression profiles showed more similarity between gestational and type 1 diabetes rather than between type 2 and gestational diabetes, a finding that was not influenced by patient gender and age. The meta-analysis of the three types of diabetes disclosed 3,747 differentially and significantly expressed genes. A total of 486 genes were characteristic of gestational diabetes, 202 genes of type 1, and 651 genes of type 2 diabetes. 19 known genes were shared by type 1, type 2 and gestational diabetes, highlighting EGF, FAM46C, HBEGF, ID1, SH3BGRL2, VEPH1, and TMEM158 genes. The meta-analysis of PBMC transcription profiles characterized each type of diabetes revealing that gestational and type 1 diabetes were transcriptionally related.

Classification of diabetes in pregnancy: time to reassess the alphabet.

The White classification is a system of alphabetically designated categories of diabetes in pregnancy based on age at onset, duration of disease, and the presence or absence of vascular complications. The original classification system underwent several revisions, each progressively increasing in detail and complexity. Individual authors and institutions have modified the classes, resulting in identically lettered classes having different definitions. Some publications make reference to the class of diabetes by letter without providing a reference defining that class. Despite a 1994 American College of Obstetricians and Gynecologists Bulletin, which suggested that the White classification system was less helpful, publications still appear using lettered designations with and without modifications and with and without attendant definitions of terms. A clinically useful system of disease classification should consist of clearly defined, mutually exclusive, easily remembered categories. The current American Diabetes Association classification of diabetes fulfills these requirements and is applicable to diabetes during pregnancy. Adoption of such a system by the obstetrics community in verbal and written medical communication will likely enhance patient care and facilitate accurate data collection and comparison.

Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study.

OBJECTIVE: The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. METHODS: This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. RESULTS: OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26-3.97); Middle Easterners, OR 2.13 (1.12-4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05-1.13)) and ethnic minority origin (South Asians, 2.54 (1.56-4.13)) were independent predictors, while education, body height and family history had little impact. CONCLUSION: GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweight.

Matching diagnosis and management of diabetes in pregnancy to local priorities and resources: an international approach.

The International Association of the Diabetes and Pregnancy Study Groups' (IADPSG) criteria for the diagnosis and classification of hyperglycemia in pregnancy are described and application of these in differing healthcare contexts on a worldwide basis is reported. Existing local protocols and known epidemiologic and clinical data regarding the detection and management of overt diabetes and gestational diabetes in the context of human pregnancy are considered. Although the IADPSG criteria are uniform, their introduction poses a variety of practical and technical challenges in differing healthcare contexts, both between and within countries. Knowledge of local factors will be vital in the implementation of the new guidelines and will require extensive liaison with local clinical and health policy groups. Resource availability will be critical in determining the type of treatment available in this context. The IADPSG criteria offer an important opportunity for a uniform approach to diabetes in pregnancy. Scaled implementation of these criteria adapted to a variety of local healthcare contexts should improve both research endeavors and patient care.

Screening and diagnosing gestational diabetes mellitus revisited: implications from HAPO.

Screening and diagnosis of gestational diabetes has lacked uniform criteria both nationally and internationally. In addition, the relationship between the degree of hyperglycemia or glucose intolerance and the risk of maternal, fetal, and neonatal adverse outcomes has not been clearly established. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently published their recommendation for diagnosing and classifying gestational hyperglycemia in pregnancy after evaluation of the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) observational study. Their recommendations have recently been accepted by the American Diabetes Association and are currently under review by the American College of Obstetricians and Gynecologist (ACOG) in the United States. If accepted in the United States and internationally, the world would have consistent thresholds for evaluating hyperglycemia in pregnancy, which would not only include the diagnosis of gestational diabetes mellitus but also overt diabetes, which has not been encompassed by previously accepted definitions.

Clinical characteristics of fulminant type 1 diabetes associated with pregnancy in China.

To report 12 cases of pregnancy-associated fulminant type 1 diabetes mellitus (PF) found in China from 2003 to 2010. The clinical and biochemical characteristics of these cases with PF were compared with a group of cases of child-bearing age with fulminant type 1 diabetes that was not associated with pregnancy (NPF). The clinical and biochemical characteristics of 12 PF cases were analyzed retrospectively and then compared with those characteristics of 20 NPF cases in China. The difference between Chinese and Japanese PF cases was investigated. The mean values of the characteristics from PF and NPF cases in China, including postprandial serum C-peptide concentration, plasma glucose concentration, and serum chloride were different. Compared to the 22 PF cases in Japan, the mean age of these 12 PF cases was much younger. The mean fasting and postprandial serum C-peptide concentration level were lower, and the mean HbA1c levels was higher in 12 PF cases in China. Eight of 12 PF cases in China developed the disease during pregnancy. Other four PF case developed the disease within 2 weeks after delivery. 12 PF cases in China showed more severe beta-cell destruction, the prognosis of their fetuses was extremely poor.

New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome.

AIMS: The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Consensus Panel recommends new criteria for diagnosing gestational diabetes. We evaluated the clinical and metabolic characteristics, and pregnancy outcome, in women previously classifiable as 'normal' according to the 4th International Workshop Conference on gestational diabetes criteria, but reclassified as 'abnormal' according to the new recommendations. METHODS: Using the new IADPSG criteria, 3953 pregnancies were retrospectively reclassified as 1815 women with normal glucose tolerance and 2138 with gestational diabetes, 112 (2.8%) of whom would have been classified as normal according to the older criteria. RESULTS: Of the 2138 women classified as abnormal by the new criteria, the 112 women now reclassified as abnormal were younger and had a lower pre-pregnancy BMI than the 2026 women who had also been classified as abnormal by the previous criteria. The 100-g oral glucose tolerance test showed significantly higher glucose levels in these 112 women than in the 1815 women reclassified as normal (P < 0.0001). Caesarean section was significantly more frequent (P < 0.01) and the ponderal index for the newborn significantly higher in these reclassified women than in those classified as normal (P < 0.0001), and their basal glucose levels correlated significantly with the ponderal index (P < 0.05). CONCLUSION: The new criteria for diagnosing gestational diabetes identified a group of women previously classifiable as normal according to the 4th International Workshop Conference criteria, but revealing metabolic characteristics and pregnancy outcomes resembling those of women who would have been considered to have gestational diabetes by the previous criteria.