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1

[Obstetric consequences of uncontrolled gestational diabetes--a case study].  

PubMed

This paper presents a case of a pregnant woman who was admitted to the obstetrics and gynecology department because of a new onset of uncontrolled diabetes in 27 weeks gestation. The maternal and fetal diabetic complications suggested a chronic character of the disease which must have been undiagnosed before pregnancy. Many of the co-existing infections caused a life-threatening ketoacidosis. Fortunately with the adequate treatment it was possible to ensure appropriate birth weight of the newborn baby despite the ultrasound markers for LGA (Large For Gestational Age) observed during pregnancy. Intensive insulin therapy was obligatorily continued by the mother after the delivery. PMID:21957610

Murlewska, Julia; Pietryga, Marek; Bagnosz-Magnuszewska, Alina; Zawiejska, Agnieszka; Brazert, Jacek; Gadzinowski, Janusz; Wender-Ozegowska, Ewa

2011-08-01

2

Gestational diabetes  

MedlinePLUS

Gestational diabetes is high blood sugar ( diabetes ) that starts or is first diagnosed during pregnancy. ... woman's blood. You are at greater risk for gestational diabetes if you: Are older than 25 when you ...

3

How to Treat Gestational Diabetes  

MedlinePLUS

... today. Home > Diabetes Basics > Gestational How to Treat Gestational Diabetes Listen Because gestational diabetes can hurt you and ... you, and a healthy start for your baby. Gestational diabetes – Looking ahead Gestational diabetes usually goes away after ...

4

Gestational diabetes: diagnosis and management  

Microsoft Academic Search

Purpose:To review the diagnosis and management of gestational diabetes.Epidemiology:In the United States, approximately 2 to 5% of all pregnant women have gestational diabetes. Those women with a family history of type 2 diabetes mellitus, Asian or native American race, Latina ethnicity or obesity are at higher risk for developing gestational diabetes.Conclusion:Women with gestational diabetes who are treated appropriately can achieve

Y W Cheng; A B Caughey

2008-01-01

5

Controversies around gestational diabetes  

Microsoft Academic Search

ABSTRACT 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 off ers level III evidence. Much of the literature on treatment is also level

Len Kelly; FCFP Laura Evans; MCP David Messenger

6

Sequelae of unrecognized gestational diabetes  

Microsoft Academic Search

OBJECTIVE: Prior studies have suggested that macrosomia is the only morbid condition associated with gestational diabetes and that this association is the result of confounding by maternal obesity rather than a result of gestational diabetes itself. We sought to determine whether unrecognized gestational diabetes is an independent predictor of macrosomia and other perinatal morbid conditions after controlling for confounding variables.

Kristina M. Adams; Hongzhe Li; Roger L. Nelson; Paul L. Ogburn Jr.; Diana R. Danilenko-Dixon

1998-01-01

7

Gestational Diabetes: A Review  

PubMed Central

Gestational diabetes mellitus is a relatively common complication of pregnancy. The incidence varies from 1.6% to 13%, depending on the criteria used for evaluating glucose tolerance in studies where universal screening was employed. The glucose-challenge screening test produces many false-positive results; the patients thus identified are then subjected to further unpleasant oral glucose-tolerance tests to make the diagnosis. The diagnosis labels many pregnant patients as “high risk” and exposes them to a cascade of interventions. The author examines the basis in the literature for universal screening practices. The recommendations of the Second International Workshop-Conference on Gestational Diabetes Mellitus are presented. The author discusses risks and benefits of alternative screening approaches, diagnosis, control, and reviews the current literature.

Levitt, Cheryl

1988-01-01

8

Gestational diabetes survey  

Microsoft Academic Search

OBJECTIVE: Our purpose was to determine how residents in obstetrics and gynecology and fellows in maternal-fetal medicine are currently being trained to diagnose and manage gestational diabetes mellitus.STUDY DESIGN: Questionnaire were mailed to 202 obstetrics and gynecology residency program directors and 78 maternal-fetal medicine fellowship directors.RESULTS: Sixty-four (82%) of the maternal-fetal medicine directors versus 142 (70%) of the residency directors

John Owen; T. Phelan; Mark B. Landon; Steven G. Gabbe

1995-01-01

9

[Gestational diabetes mellitus].  

PubMed

Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes. GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit (Evidence level B) is recommended in women at increased risk using standard diagnostic criteria (high risk: history of GDM or pre-diabetes (impaired fasting glucose or impaired glucose tolerance); malformation, stillbirth, successive abortions or birthweight > 4,500 g in previous pregnancies; obesity, metabolic syndrome, age > 45 years, vascular disease; clinical symptoms of diabetes (e.g. glucosuria). Performance of the OGTT (120 min; 75 g glucose) may already be indicated in the first trimester in some women but is mandatory between 24 and 28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (Evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study GDM is defined, if fasting venous plasma glucose exceeds 92 mg/dl or 1 h 180 mg/dl or 2 h 153 mg/dl after glucose loading (OGTT; international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl) insulin therapy should be initiated. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria) 6-12 weeks postpartum and every 2 years in case of normal glucose tolerance (Evidence level B). All women have to be instructed about their (sevenfold increased relative) risk of type 2 diabetes at follow-up and possibilities for diabetes prevention, in particular weight management and maintenance/increase of physical activity. Monitoring of the development of the offspring and recommendation of healthy lifestyle of the children and family is recommended. PMID:23250453

Kautzky-Willer, Alexandra; Bancher-Todesca, Dagmar; Pollak, Arnold; Repa, Andreas; Lechleitner, Monika; Weitgasser, Raimund

2012-12-01

10

Prevention of Gestational Diabetes  

PubMed Central

OBJECTIVE To examine the feasibility of an individualized exercise program to prevent gestational diabetes mellitus (GDM) in obese pregnant women. RESEARCH DESIGN AND METHODS The study was a pilot randomized controlled trial with obese pregnant women (intervention group, individualized exercise program [n = 25]; control group, usual care [n = 25]). Average weekly energy expenditure (MET hours per week and kilocalories per week) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Questionnaire. Fasting glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed at baseline and 20, 28, and 36 weeks' gestation. RESULTS Of the women in the intervention group, 16 of 22 (73%) achieved more than 900 kcal/week of exercise-based activity at 28 weeks compared with 8 of 19 women in the control group (42%), P = 0.047. However, insulin resistance (HOMA-IR) did not differ between the groups. CONCLUSION This intervention was feasible and prompted a modest increase in physical activity. However, we are not confident that this intervention would be sufficient to prevent GDM.

Callaway, Leonie K.; Colditz, Paul B.; Byrne, Nuala M.; Lingwood, Barbara E.; Rowlands, Ingrid J.; Foxcroft, Katie; McIntyre, H. David

2010-01-01

11

Preventing diabetes in women with gestational diabetes.  

PubMed

The immediate consequences of gestational diabetes on pregnancy are well known but the complications decades later for the mother and child are just now emerging. This trio of papers discuss the long-term consequences of gestational diabetes, the importance of screening this high risk group of women for type 2 diabetes, and the evidence for lifestyle, medications and breastfeeding for the prevention of type 2 diabetes in these women. PMID:22228710

Feig, Denice

2012-05-01

12

Gestational Diabetes and Thyroid Autoimmunity  

PubMed Central

Background. About 10% of pregnancies are complicated by previously unknown impairment of glucose metabolism, which is defined as gestational diabetes. There are little data available on prevalence of thyroid disorders in patients affected by gestational diabetes, and about their postgestational thyroid function and autoimmunity. We therefore investigated pancreatic and thyroid autoimmunity in gestational diabetic patients and in women who had had a previous gestational diabetic pregnancy. Methods. We investigated 126 pregnant women at the time of a 100-g oral glucose tolerance test: 91 were classified as gestational diabetics, and 35 were negative (controls). We also studied 69 women who had delivered a baby 18–120 months prior to this investigation and who were classified at that time gestational diabetics (38 women) or normally pregnant (31 women; controls). Results. Our data show no differences for both thyroid function and prevalence of autoimmune disorders during pregnancy; however, a significant increase in thyroid autoimmunity was seen in women previously affected by gestational diabetes. This increased prevalence of thyroid autoimmunity was not associated with the development of impaired glucose metabolism after pregnancy. Conclusions. Our data suggest that maternal hyperglycemia is a risk factor for the development of thyroid autoimmunity, a conclusion that should now be confirmed in a larger cohort of patients.

Vitacolonna, Ester; Lapolla, Annunziata; Di Nenno, Barbara; Passante, Annalisa; Bucci, Ines; Giuliani, Cesidio; Cerrone, Dominique; Capani, Fabio; Monaco, Fabrizio; Napolitano, Giorgio

2012-01-01

13

Controversies around gestational diabetes  

PubMed Central

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.

Kelly, Len; Evans, Laura; Messenger, David

2005-01-01

14

Assessing the risk of gestational diabetes in twin gestation.  

PubMed Central

This study examines the hypothesis that twin gestation is a risk factor for gestational diabetes. In a retrospective analysis, the incidence of gestational diabetes in twin and singleton pregnancies was determined in groups matched for maternal age, weight, and parity. One-hour oral glucose challenge tests (50 g) were used to screen 9185 pregnant women. Gestational diabetes was diagnosed when abnormal screens (> or = 130 mg/dL) were followed by two or more abnormal values on a 3-hour (100 g) glucose tolerance test using National Diabetes Data Group (NDDG) criteria. A twin gestation was identified in 1.5% (138/9185) of the pregnancies. Gestational diabetes was diagnosed in 5.8% (8/138) and 5.4% (439/9047) of the twin and singleton pregnancies, respectively. The incidence of gestational diabetes is similar for singleton and twin gestations.

Henderson, C. E.; Scarpelli, S.; LaRosa, D.; Divon, M. Y.

1995-01-01

15

Clinical diagnosis of gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) diagnosis remains controversial. ACOG criteria are based on the long-term risk of maternal diabetes. ADA recently suggested diagnosing GDM with 1 elevated value on an oral glucose tolerance test based on a 1.75-fold risk of large-for-gestational age infants resulting in a 17.8% rate of GDM. Given the lack of neonatal-based outcomes for the traditional position and problems of reproducibility and benefit/harm balance of the ADA approach, an alternative is presented herein based on a 2-fold risk of a large-for-gestational age baby, requiring 2 separate abnormalities to reduce false positives giving a more balanced benefit/harm ratio (10% GDM rate). PMID:24005127

Ryan, Edmond A

2013-12-01

16

Detecting and managing gestational diabetes.  

PubMed Central

Gestational diabetes is an asymptomatic metabolic disorder of pregnancy associated with increased morbidity in mother and fetus. Early detection and intervention improve pregnancy outcome. This article reviews the current approach to diagnosis and management. Specific guidelines for nutritional management and insulin use are included.

Blair, M. M.; Noc, A. M.

1993-01-01

17

[Patient education of gestational diabetes].  

PubMed

Gestational diabetes is hyperglycaemia detected during pregnancy. Recent studies have shown the benefit of the intensive management of this form of diabetes in limiting the repercussions on the mother and foetus. Therapeutic education is an integral part of the support given to these patients. Based on a self-assessment of its educational practices, the diabetologyteam at the University Hospital of Besançon has focused on a management of the condition centred on technical and dietary aspects. For every issue, areas of improvement were suggested, implemented and assessed. PMID:23785963

Filiatre, Caroline; Zimmermann, Cécile

2013-05-01

18

Gestational diabetes: a non-entity?  

Microsoft Academic Search

Screening for gestational diabetes is commonly recommended despite the absence of a common definition of gestational diabetes. Furthermore, there is no consensus about management or treatment. Those who recommend screening do so largely on the basis of fetal morbidity, which seems to be predominantly \\

R J Jarrett

1993-01-01

19

The management of gestational diabetes.  

PubMed

The incidence of gestational diabetes is increasing, with higher obesity in the pregnant population, lifestyle changes and migration thought to underlie this. Recent large studies, such as the MiG, HAPO and ACHOIS trials, have furthered our understanding of both the implications of the disease and the management options available. Previous CEMACH (Confidential Enquiries into Maternal and Child Health) studies of diabetes in pregnancy have shown a significant proportion of patients receiving sub-optimal care. We aim to summarise the current standard of management strategies in pregnancy, whilst acknowledging controversies and limitations in the existing evidence. Antenatal management involves service organisation to provide multi-disciplinary team reviews to address glycaemic control, fetal monitoring and associated conditions such as obesity and hypertensive disorders of pregnancy. The use of diet, exercise, oral hypoglycaemic agents and insulins will be discussed, along with specific considerations for the management of preterm labour and administration of corticosteroids for fetal lung maturity. The timing and management of labour, including mechanisms of delivery, will be covered, including neonatal considerations and the use of breast feeding. Finally, a discussion of appropriate post delivery care will consider the prevention of, and screening for, the development of type 2 diabetes. PMID:22587510

Ovadia, Caroline; Dixit, Archana

2012-07-01

20

Understanding Gestational Diabetes: A Practical Guide to a Healthy Pregnancy.  

ERIC Educational Resources Information Center

|This brochure addresses the problem of gestational diabetes and answers the most frequently asked questions about the disease. It begins by defining gestational diabetes and discussing its cause, then addresses such topics as: (1) how gestational diabetes differs from other types of diabetes; (2) who is at risk for developing gestational diabetes

National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

21

[Gestational diabetes insipidus during a twin pregnancy].  

PubMed

Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP. PMID:23380272

De Mesmay, M; Rigouzzo, A; Bui, T; Louvet, N; Constant, I

2013-02-04

22

Managing Gestational Diabetes. A Patient's Guide to a Healthy Pregnancy.  

National Technical Information Service (NTIS)

Managing Gestational Diabetes: A Patient's Guide to a Healthy Pregnancy provides some general guidelines for keeping yourself healthy and for promoting the best outcomes for your baby, if you have gestational diabetes. The booklet describes gestational di...

2004-01-01

23

Gestational diabetes mellitus diagnosed during early pregnancy  

Microsoft Academic Search

Objective: This study was undertaken to compare pregnancy complications, obstetric outcomes, and perinatal outcomes between women with early-onset and late-onset gestational diabetes mellitus. Study Design: Fifty-gram oral glucose challenge screening was conducted among 3986 pregnant women at the time of their first antenatal visit. Women without abnormal results underwent another test at 24 to 28 weeks’ gestation. Patients with gestational

Jose L. Bartha; Pilar Martinez-Del-Fresno; Rafael Comino-Delgado

2000-01-01

24

Gestational Diabetes in Korea: Incidence and Risk Factors of Diabetes in Women with Previous Gestational Diabetes  

PubMed Central

Korean women with a history of gestational diabetes mellitus (GDM) have a 3.5 times greater risk of developing postpartum diabetes than the general population. The incidence of type 2 diabetes mellitus in early postpartum is reported as 10-15% in Korean women. A prospective follow-up study on Korean women with GDM showed that approximately 40% of women with previous GDM were expected to develop diabetes within 5 years postpartum. Independent risk factors for the development of diabetes in Korean women with previous GDM are pre-pregnancy body weight, gestational age at diagnosis, antepartum hyperglycemia on oral glucose tolerance test, low insulin response to oral glucose load, and family history of diabetes. Women with postpartum diabetes have greater body mass indexes, body weight, and waist circumferences than women with normal glucose tolerance. Multiple logistic regression analysis has revealed that waist circumference is the strongest obesity index along with systolic blood pressure and that triglyceride levels are a major independent risk factor for developing diabetes. These results in Korean women with previous GDM underline the importance of postpartum testing in Korean women diagnosed with GDM, and demonstrate that impaired B-cell function, obesity, and especially visceral obesity, are associated with the development of diabetes.

2011-01-01

25

COMMENTARY Gestational Diabetes: Risk or Myth?  

Microsoft Academic Search

There is a wide spectrum of views regarding the clinical significance of the entity known as gestational diabetes mel- litus (GDM). At one end of the spectrum are advocates of strict evidence-based medical care who argue that there is insufficient evidence for preventable morbidity resulting from asymptomatic maternal hyperglycemia during preg- nancy to warrant routine detection and treatment of GDM.

THOMAS A. BUCHANAN; SIRI L. KJOS

26

Polycystic Ovaries in Women With Gestational Diabetes  

Microsoft Academic Search

Objective: To examine the occurrence of polycystic ovaries (PCO) in women with gestational diabetes mellitus (GDM).Methods: This was a retrospective comparative study of ultrasonographic findings of ovaries in 31 women with GDM and 30 healthy controls matched according to maternal age and body mass index (BMI). Women who presented evidence of impaired glucose tolerance during pregnancy were excluded from the

L Anttila; K Karjala; T.-A Penttilä; K Ruutiainen; U Ekblad

1998-01-01

27

Gestational diabetes mellitus: taking it to heart.  

PubMed

Globally, cardiovascular disease (CVD) accounts for 1/3 of all deaths to women. While much research identifies the increased risk in CVD associated with pre-diabetes measurements, there is growing interest in the role of gestational diabetes mellitus (GDM)-a condition of glucose intolerance diagnosed during pregnancy-as a potential CVD risk factor. This article reviews existing evidence supporting this association, particularly regarding GDM and type 2 diabetes, hypertension, atherogenic dyslipedmia, and CVD events. Finally, it discusses the research and clinical ramifications of identifying GDM as a CVD risk factor, highlighting the need for more rigorous research on this topic. PMID:21106447

Marcinkevage, Jessica A; Narayan, K M Venkat

2010-11-23

28

Prevalence of gestational diabetes in a Navajo Indian community.  

PubMed Central

A retrospective analysis of 4,094 deliveries among Navajo Indian women was carried out to determine the prevalence of gestational diabetes mellitus and diabetes antedating pregnancy. Three data sources--a local prenatal registry, a delivery room log, and hospital discharge records--were evaluated for their usefulness as surveillance systems for gestational diabetes. In all, 177 cases of gestational diabetes and 13 cases of preexisting diabetes were identified, giving a prevalence of maternal diabetes in pregnancy of 4.6%. When women with preexisting diabetes or documented gestational diabetes during a previous pregnancy were excluded, the prevalence of gestational diabetes during the study period was 3.4%. Although each data source used separately failed to identify 20% to 40% of diabetic pregnancies, more than 97% of cases were identified using a combination of the prenatal registry and the delivery log.

Sugarman, J R

1989-01-01

29

Adiponectin SNP45TG is associated with gestational diabetes mellitus  

Microsoft Academic Search

Introduction  Diabetes and pregnancy can be associated in two ways: pregnancy that occurs in women who are already diabetic (diabetes of\\u000a pre-gestational origin); and diabetes that occur in women who are already pregnant [gestational diabetes mellitus (GDM) (O’sullivan\\u000a 1961)]. Patients with previous GDM history have higher risk of developing diabetes outside of pregnancy. Accumulating literature\\u000a had suggested that adiponectin plays a

Chen Fei Low; Eusni Rahayu Mohd Tohit; Pei Pei Chong; Faridah Idris

2011-01-01

30

Vaginal birth after cesarean among women with gestational diabetes  

Microsoft Academic Search

Objective: We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery. Study Design: We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attempted vaginal birth after cesarean at Grady Memorial Hospital, Atlanta, from January 1, 1989, through December

Traci L. Coleman; Hugh Randall; William Graves; Michael Lindsay

2001-01-01

31

Gestational Diabetes Mellitus: A Positive Predictor of Type 2 Diabetes?  

PubMed Central

The aim of this paper is to consider the relative benefits of screening for type two diabetes mellitus in women with a previous pregnancy complicated by gestational diabetes mellitus. Recent studies suggest that women who experience GDM are at a greater risk of developing type 2 diabetes within 10–20 years of their index pregnancy. If considered as a stand-alone indicator of the risk of developing type 2 diabetes, GDM is a poor diagnostic test. Most women do not develop GDM during pregnancy and of those that do most do not develop type 2 diabetes. There is, however, a clear need for better early detection of predisposition to disease and/or disease onset to significantly impact on this global pandemic. The putative benefits of multivariate approaches and first trimester and preconception screening to increase the sensitivity of risk assignment modalities for type 2 diabetes are proposed.

Rice, Gregory E.; E. Illanes, Sebastian; Mitchell, Murray D.

2012-01-01

32

A Comparative Study of Relationship between Micronutrients and Gestational Diabetes  

PubMed Central

In this paper, we studied the relation between the micronutrient and gestational diabetes. Therefore, we measured micronutrient concentration including Ni, Al, Cr, Mg, Fe, Zn, Cu, and Se in serum of women with gestational diabetes between 24 and 28 weeks of gestational age (study group) who had inclusion criteria and comparison with micronutrient levels in normal pregnant women with same gestational age (control group). Results showed that there was no significant difference between the serum micronutrient level (Ni, Al, Cr, Mg, Zn, Cu, Se) in study and control groups except serum level of iron which in serum of gestational diabetic women was lower than normal pregnant women and difference was significant.

Akhlaghi, Farideh; Bagheri, Seyyed Majid; Rajabi, Omid

2012-01-01

33

Potential Mechanisms of Exercise in Gestational Diabetes  

PubMed Central

Gestational diabetes mellitus (GDM) is defined as glucose intolerance first diagnosed during pregnancy. This condition shares same array of underlying abnormalities as occurs in diabetes outside of pregnancy, for example, genetic and environmental causes. However, the role of a sedentary lifestyle and/or excess energy intake is more prominent in GDM. Physically active women are less likely to develop GDM and other pregnancy-related diseases. Weight gain in pregnancy causes increased release of adipokines from adipose tissue; many adipokines increase oxidative stress and insulin resistance. Increased intramyocellular lipids also increase cellular oxidative stress with subsequent generation of reactive oxygen species. A well-planned program of exercise is an important component of a healthy lifestyle and, in spite of old myths, is also recommended during pregnancy. This paper briefly reviews the role of adipokines in gestational diabetes and attempts to shed some light on the mechanisms by which exercise can be beneficial as an adjuvant therapy in GDM. In this regard, we discuss the mechanisms by which exercise increases insulin sensitivity, changes adipokine profile levels, and boosts antioxidant mechanisms.

Golbidi, Saeid; Laher, Ismail

2013-01-01

34

Effect of Uncontrolled Diabetes on Plasma Ghrelin Concentrations and Ghrelin-Induced Feeding  

Microsoft Academic Search

Plasma levels of the orexigenic hormone, ghrelin, decrease rapidly on nutrient ingestion and yet are paradoxically ele- vated in rats with hyperphagia induced by streptozotocin- induced diabetes (STZ-DM). In the current work, we investi- gated the mechanisms underlying the relationships among uncontrolled diabetes, food intake, and plasma ghrelin con- centrations in an effort to clarify whether increased ghrelin signaling contributes

RICHARD W. GELLING; JOOST OVERDUIN; CHRISTOPHER D. MORRISON; GREGORY J. MORTON; R. SCOTT FRAYO; DAVID E. CUMMINGS; MICHAEL W. SCHWARTZ

2004-01-01

35

[Postpartum and contraception after gestational diabetes].  

PubMed

Women who had gestational diabetes must have their glycemia closely checked after delivery to insure complete normalization. Few studies are published but breast feeding does not seem to modify the metabolic profile of the mother or the children. Contraception must take account associated risk factors. Very few studies are published and none notified a significant modification of the carbohydrate metabolism with hormonal contraception, either estroprogestative or progestative only. But associated obesity, hypertension or dyslipidemia need the prescription of a contraception with no vascular secondary effect. In these cases an intrauterine device represents a very good choice. PMID:21185480

Kerlan, V

2010-12-01

36

Risk Factors for Type 2 Diabetes Among Women with Gestational Diabetes: A Systematic Review  

Microsoft Academic Search

We conducted a systematic review of studies examining risk factors for the development of type 2 diabetes among women with previous gestational diabetes. Our search strategy yielded 14 articles that evaluated 9 categories of risk factors of type 2 diabetes in women with gestational diabetes: anthropometry, pregnancy-related factors, postpartum factors, parity, family history of type 2 diabetes, maternal lifestyle factors,

Kesha Baptiste-Roberts; Bethany B. Barone; Tiffany L. Gary; Sherita H. Golden; Lisa M. Wilson; Eric B. Bass; Wanda K. Nicholson

2009-01-01

37

Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon city)  

Microsoft Academic Search

Objective: The purposes of this study were to determine the prevalence of gestational diabetes mellitus (GDM) in Trabzon city of Turkey and to identify appropriate risk factors for gestational diabetes in pregnant mothers. Research design and methods: Eight hundred and seven adult pregnant women were screened for GDM with a 1-hour, 50 g oral glucose challenge test (GCT). Three-hour, 100

Cihangir Erem; Nihat Cihanyurdu; Orhan Deger; Caner Karahan; Gamze Çan; Münir Telatar

2003-01-01

38

Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes  

Microsoft Academic Search

The objective of this study was to determine the incidence of gestational diabetes mellitus (GDM) and compare fetal, maternal and neonatal complications amongst women with GDM and pregnant women with normal glucose tolerance in an urban Iranian population. In a prospective cohort study, universal screening for gestational diabetes mellitus was performed for 1310 pregnant women who were referred from private

Maryam Keshavarz; N. Wah Cheung; Gholam Reza Babaee; Hamid Kalalian Moghadam; Mohammad Esmail Ajami; Mohammad Shariati

2005-01-01

39

Excessive Early Gestational Weight Gain And Risk of Gestational Diabetes Mellitus in Nulliparous Women  

PubMed Central

Objective To estimate whether there is an association between excessive early gestational weight gain and the development of gestational diabetes mellitus (GDM) and excessive fetal growth. Methods This is a secondary analysis of a randomized controlled trial of vitamins C and E in nulliparous low-risk women. Maternal weight gain from prepregnancy (self-reported) to 15–18 weeks of gestation was measured, and expected gestational weight gain was determined using the Institute of Medicine (IOM) 2009 guidelines for each prepregnancy body mass index (BMI) category. Excessive early gestational weight gain was defined as gestational weight gain greater than the upper range of the IOM guidelines. Rates of GDM, birth weight greater than 4000g, and large for gestational age ([LGA], birth weight 90th percentile or higher) were calculated and compared between women with excessive early gestational weight gain and early nonexcessive gestational weight gain (within or below IOM guidelines). Results A total of 7,985 women were studied. Excessive early gestational weight gain occurred in 47.5% of women. Ninety-three percent of women with excessive early gestational weight gain had total gestational weight gain greater than IOM guidelines. In contrast, only 55% of women with nonexcessive early gestational weight gain had total gestational weight gain greater than IOM guidelines (p<0.001). Rates of GDM, LGA, and birth weight greater than 4000 grams were higher in women with excessive early gestational weight gain. Conclusions In our population, excessive early gestational weight gain occurred in 93% of women who had total gestational weight gain greater than the IOM guidelines. In low-risk nulliparous women, excessive early gestational weight gain is associated with the development of GDM and excessive fetal growth.

Carreno, Carlos A.; Clifton, Rebecca G.; Hauth, John C.; Myatt, Leslie; Roberts, James M.; Spong, Catherine Y.; Varner, Michael W.; Thorp, John M.; Mercer, Brian M.; Peaceman, Alan M.; Ramin, Susan M.; Carpenter, Marshall W.; Sciscione, Anthony; Tolosa, Jorge E.; Sorokin, Yoram

2012-01-01

40

Gestational diabetes: risks, management, and treatment options  

PubMed Central

Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring.

Kim, Catherine

2010-01-01

41

Finding Genetic Risk Factors of Gestational Diabetes  

PubMed Central

Gestational diabetes mellitus (GDM) is a complex metabolic disorder of pregnancy that is suspected to have a strong genetic predisposition. It is associated with poor perinatal outcome, and both GDM women and their offspring are at increased risk of future development of type 2 diabetes mellitus (T2DM). During the past several years, there has been progress in finding the genetic risk factors of GDM in relation to T2DM. Some of the genetic variants that were proven to be significantly associated with T2DM are also genetic risk factors of GDM. Recently, a genome-wide association study of GDM was performed and reported that genetic variants in CDKAL1 and MTNR1B were associated with GDM at a genome-wide significance level. Current investigations using next-generation sequencing will improve our insight into the pathophysiology of GDM. It would be important to know whether genetic information revealed from these studies could improve our prediction of GDM and the future development of T2DM. We hope further research on the genetics of GDM would ultimately lead us to personalized genomic medicine and improved patient care.

Kwak, Soo Heon; Jang, Hak C.

2012-01-01

42

Gestational diabetes: risks, management, and treatment options.  

PubMed

Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring. PMID:21151681

Kim, Catherine

2010-10-07

43

Maternal Serum Adiponectin Multimers In Gestational Diabetes  

PubMed Central

Objective Adiponectin, an adipokine with profound insulin-sensitizing effect, consists of heterogeneous species of multimers. These oligomeric complexes circulate as low-molecular-weight (LMW) trimers, medium-molecular-weight (MMW) hexamers and high-molecular-weight (HMW) isoforms and can exert differential biological effects. The aims of this study were to determine whether there is a change in circulating adiponectin multimers in the presence of gestational diabetes mellitus (GDM), overweight/obesity or with a treatment with sulfonylurea or insulin in patients with GDM. Study design This cross-sectional study included women with: 1) normal pregnancy (n=149); and 2) patients with GDM (n=72). Thirty three patients with GDM were managed with diet alone. Among the others 39 diabetic patients, 17 were treated with Glyburide and 22 with insulin. The study population was further stratified by first trimester BMI (normal weight <25 kg/m2 vs. overweight/obese ?25 kg/m2). Serum adiponectin multimers (total, HMW, MMW and LMW) concentrations were determined by ELISA. Results 1) The median maternal serum of total, HMW, MMW and LMW were lower in patients with GDM than in those with normal pregnancies (p<0.001 for all comparisons); 2) patients with GDM had a lower HMW/Total adiponectin ratio and a higher MMW/Total and LMW/Total adiponectin ratio than those with a normal pregnancy (p<0.001 for all comparisons); and 3) among GDM patients, there were no differences in the concentrations and relative distribution of adiponectin multimers between those who were managed with diet, and those who were treated with pharmacological agents. Conclusion 1) GDM is characterized by a distinctive pattern of concentrations and relative distribution of adiponectin multimers akin to Type-2 diabetes mellitus; 2) dysregulation of adiponectin multimeres can provide a mechanistic basis for the association between adiposity and GDM.

Mazaki-Tovi, Shali; Romero, Roberto; Vaisbuch, Edi; Erez, Offer; Mittal, Pooja; Chaiworapongsa, Tinnakorn; Kim, Sun Kwon; Pacora, Percy; Yeo, Lami; Gotsch, Francesca; Dong, Zhong; Yoon, Bo Hyun; Hassan, Sonia S.; Kusanovic, Juan Pedro

2013-01-01

44

Metformin Versus Insulin for the Treatment of Gestational Diabetes  

Microsoft Academic Search

Methods We randomly assigned 751 women with gestational diabetes mellitus at 20 to 33 weeks of gestation to open treatment with metformin (with supplemental insulin if re- quired) or insulin. The primary outcome was a composite of neonatal hypoglycemia, respiratory distress, need for phototherapy, birth trauma, 5-minute Apgar score less than 7, or prematurity. The trial was designed to rule

Janet A. Rowan; William M. Hague; Wanzhen Gao; Malcolm R. Battin

2009-01-01

45

Modulation of Adipokines and Cytokines in Gestational Diabetes and Macrosomia  

Microsoft Academic Search

Context\\/Objective: Not much is known about the implication of adipokines and different cytokines in gestational diabetes mellitus (GDM) and macrosomia. The purpose of this study was to assess the profile of these hormones and cytokines in macrosomic babies, born to gestational diabetic women. Design\\/Subjects: A total of 59 women (age, 19-42 yr) suffering from GDM with their macrosomic babies (4.35

J.-M. Ategbo; O. Grissa; A. Yessoufou; A. Hichami; K. L. Dramane; K. Moutairou; A. Miled; A. Grissa; M. Jerbi; Z. Tabka; N. A. Khan

2006-01-01

46

Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes  

Microsoft Academic Search

Background: Diabetes type 1 is associated with an increased risk for infant congenital malformations. It is debated whether this is true also at gestational diabetes. Aims: To study occurrence of congenital malformations in infants whose mothers had preexisting or gestational diabetes. Study design: A register study covering over 1.2 million Swedish births in 1987–1997 based on the Swedish health registries.

Anders Åberg; Lena Westbom; Bengt Källén

2001-01-01

47

Perinatal Outcomes for Women Diagnosed with Gestational Diabetes Mellitus Who Participated in an Interdisciplinary Gestational Diabetes Program.  

National Technical Information Service (NTIS)

The purpose of this descriptive study was to describe the case management process and report the perinatal outcomes of women in an interdisciplinary gestational diabetes mellitus (GDM) program. This study examined the structure of the team which implement...

K. E. Sears

1997-01-01

48

[Gestational diabetes: diagnosis, short and long term management].  

PubMed

Universal consensus on the diagnosis methods and thresholds has long been lacking. The recently published Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study has been used to confirm the link between hyperglycemia and materno-fetal complications. Consequently, in France, the Société francophone du diabète (SFD) and the Collège national des gynécologues et obstétriciens français (CNGOF) proposed an expert consensus on gestational diabetes mellitus for clinical practice. Fasting blood glucose should be measured at the first visit during early pregnancy for women with risk factors to identify the women with pregestational diabetes. It is proposed a selective screening on risk factors rather than universal screening. Specific treatment of gestational diabetes reduced materno-fetal complications compared to the absence of therapy. Women with a history of gestational diabetes mellitus are characterized by a high risk of type 2 diabetes mellitus. PMID:23588192

Vambergue, Anne

2013-04-12

49

Gestational Diabetes: Caring for Women During and After Pregnancy. Clinician's Guide.  

National Technical Information Service (NTIS)

This guide summarizes clinical evidence about prenatal treatment and delivery management for women with gestational diabetes. It also summarizes evidence about followup for the development of type 2 diabetes among women who have had gestational diabetes. ...

B. Rugge D. Hickam E. Davis M. Schechtel V. King

2009-01-01

50

Gestational Diabetes: What You Need to Know  

MedlinePLUS

National Diabetes Information Clearinghouse (NDIC) A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) , ... Statistics Research Resources Order About Us Español National Diabetes Information Clearinghouse Publications Tools and Resources E-News ...

51

Increased C282Y Heterozygosity in Gestational Diabetes  

Microsoft Academic Search

Background: Hereditary hemochromatosis is an autosomal recessive disorder of iron metabolism that is characterized by excess accumulation of iron in various organs and often leads to diabetes mellitus (DM). To study whether mutations in the hemochromatosis gene (HFE) could be a risk factor for the development of gestational diabetes mellitus (GDM), the prevalence of HFE mutations in patients with GDM

Edmund Cauza; Ursula Hanusch-Enserer; Martin Bischof; Marita Spak; Karam Kostner; Ayman Tammaa; Attila Dunky; Peter Ferenci

2005-01-01

52

Progesterone in gestational diabetes mellitus: guilty or not guilty?  

Microsoft Academic Search

Insulin resistance is one of the metabolic changes in pregnancy, but only a fraction of women develop overt impaired glucose tolerance or frank diabetes. Most women are able to compensate this altered metabolic state by increasing the amount of insulin produced by the pancreatic ? cells. Progesterone might well be the key to the development of gestational diabetes. Previously high

Dumitru D. Br?ni?teanu; Chantal Mathieu

2003-01-01

53

Determinants of uncontrolled hypertension in adult type 2 diabetes mellitus: an analysis of the Malaysian diabetes registry 2009  

PubMed Central

Background Uncontrolled blood pressure (BP) is a significant contributor of morbidity and even mortality in type 2 diabetes (T2D) patients. This study was done to determine the significant determinants of uncontrolled blood pressure in T2D patients in Malaysia. Methods Between 1st January 2009 to 31st December 2009, data from 70 889 patients with Type 2 diabetes was obtained from the Adult Diabetes Control and Management Registry for analysis; 303 centers participated in the study. Their demographic characteristics, the nature of their diabetes, their state of hypertension, treatment modalities, risk factors, and complications are described. Based on their most recent BP values, subjects were divided into controlled BP and uncontrolled BP and their clinical determinants compared. Independent determinants were identified using multivariate logistic regression. Results The mean age of patients at diagnosis of diabetes was 52.3 ± 11.1 years old. Most were women (59.0 %) and of Malay ethnicity (61.9 %). The mean duration of diabetes was 5.9 ± 5.6 years. A total of 57.4 % were hypertensive. Of the 56 503 blood pressure (BP) measured, 13 280 (23.5 %) patients had BP <130/80 mmHg. Eighteen percent was on > two anti-hypertensive agents. Health clinics without doctor, older age (? 50 years old), shorter duration of diabetes (< 5 years), Malay, overweight were determinants for uncontrolled blood pressure (BP ?130/80 mmHg). Patients who were on anti-hypertensive agent/s were 2.7 times more likely to have BP ?130/80 mmHg. Type 2 diabetes patients who had ischaemic heart disease or nephropathy were about 20 % and 15 % more likely to have their blood pressure treated to target respectively. Conclusions Major independent determinants of uncontrolled BP in our group of T2D patients were Malay ethnicity, older age, recent diagnosis of diabetes, overweight and follow-up at health clinics without a doctor and possibly the improper use of anti hypertensive agent. More effort, education and resources, especially in the primary health care centres are needed to improve hypertensive care among our patients with diabetes.

2012-01-01

54

Gestational Diabetes, Atopic Dermatitis and Allergen Sensitization in Early Childhood  

PubMed Central

Background The relationship between the prenatal environment, maternal-fetal interaction, and allergic disease in the offspring remains understudied. Objective We sought to determine whether gestational diabetes modifies the risk of early childhood atopic manifestations including atopic dermatitis and allergen sensitization. Methods This study includes 680 children from the Boston Birth Cohort. Mother-child dyads were recruited at birth and followed prospectively to a mean age of 3.2±2.3 years with study visits aligned with the pediatric primary care schedule. The primary outcomes were physician diagnosed atopic dermatitis on standardized medical record abstraction and allergen sensitization based on Immunocap to 7 common foods and 5 common aeroallergens (sIgE?0.10 kUA/L, Phadia). Gestational diabetes was determined by standardized medical record review. Logistic regression analysis, stratified by term/preterm status, evaluated the association of gestational diabetes with atopic dermatitis and allergen sensitization respectively, controlling for maternal pre-pregnancy BMI, fetal growth, and pertinent covariates. Results Of the 680 children, 488 were term and 192 were preterm (<37 weeks gestation). Overall, 4.9% of the mothers developed gestational diabetes. Among the 680 children, 34.4% developed atopic dermatitis and 51% developed allergen sensitization. In term births, gestational diabetes was significantly associated with atopic dermatitis (OR, 95%CI=7.2, 1.5-34.5) and allergen sensitization (OR, 95%CI=5.7, 1.2-28.0). Adjusting for fetal growth had little effect. The association with sensitization was driven primarily by food sensitization (OR, 95%CI=8.3, 1.6-43.3). The above associations were not observed in preterm births. Conclusions In term births, gestational diabetes increased the risk of atopic dermatitis and early childhood allergen sensitization, independent of maternal pre-pregnancy BMI and fetal growth.

Kumar, Rajesh; Ouyang, Fengxiu; Story, Rachel E; Pongracic, Jacqueline A; Hong, Xiumei; Wang, Guoying; Pearson, Colleen; Ortiz, Kathryn; Bauchner, Howard; Wang, Xiaobin

2013-01-01

55

Postpartum and contraception in women after gestational diabetes.  

PubMed

Women who have had gestational diabetes mellitus must be monitored in the immediate postpartum period to ensure that blood glucose levels return to normal without further treatment. In the few studies performed specifically in these women, those that breastfed did not have a different metabolic profile, at least during the period of breastfeeding; the metabolic profiles of children born to women that had gestational diabetes and that breastfed also did not differ from those that were not breastfed. The choice of contraception must mainly take into consideration the associated risk factors. The studies, even if few have specifically focused on women with a history of gestational diabetes, have not demonstrated a significant disturbance of glucose metabolism while using hormonal contraception, whether combined oral oestrogen/progestogen or progestogen-only contraception. However, the presence of obesity, hypertension, or dyslipidaemia must direct the choice of contraception towards one without cardiovascular consequences. In these cases, the intrauterine device is an excellent choice. PMID:21163421

Kerlan, V

2010-12-01

56

Strategies in the nutritional management of gestational diabetes.  

PubMed

Elucidating the optimal macronutrient composition for dietary management of gestational diabetes mellitus has enormous potential to improve perinatal outcomes. Diet therapy may result in significant cost savings if effective in deterring the need for expensive medical management within this growing population. In only 6 randomized controlled trials in 250 women, data suggest that a diet higher in complex carbohydrate and fiber, low in simple sugar, and lower in saturated fat may be effective in blunting postprandial hyperglycemia, preventing worsened insulin resistance and excess fetal growth. The use of diet in gestational diabetes mellitus remains an area in grave need for high-quality randomized controlled trials. PMID:24047934

Hernandez, Teri L; Anderson, Molly A; Chartier-Logan, Catherine; Friedman, Jacob E; Barbour, Linda A

2013-12-01

57

A special case of gestational diabetes mellitus.  

PubMed

We report the case of a young woman who was diagnosed with monogenic diabetes caused by a glucokinase gene mutation during the third trimester of pregnancy, requiring a change in treatment plan in comparison with her previous pregnancies. We also discuss the implications for obstetric management in patients with maturity onset diabetes of the young, type 2 (MODY-2). PMID:22974456

Azriel, Sharona; Camaño, Isabel; Montañez, Dolores; Navas, Angeles; García-Burguillo, Antonio

2009-01-07

58

Current controversies in the mechanisms and treatment of gestational diabetes  

Microsoft Academic Search

Gestational diabetes mellitus (GDM) is a heterogeneous entity, including carbohydrate intolerance of variable severity with\\u000a onset or first recognition during pregnancy. Insulin resistance and -cell dysfunction are thought to be major determinants\\u000a of its development. Its pathomechanism in many ways resembles that of type 2 diabetes. There is an evolving body of evidence\\u000a from the last decade presenting similarities between

Gyula Tamás; Zsuzsa Kerényi

2002-01-01

59

Gestational Diabetes Mellitus: Diagnosis, Maternal and Fetal Outcomes, and Management  

Microsoft Academic Search

\\u000a Gestational diabetes mellitus (GDM), or diabetes first recognized during pregnancy, is associated with increased risk of adverse\\u000a perinatal outcomes. After GDM delivery, both mothers and offspring are at risk for long-term chronic disease. Clinical recognition\\u000a and treatment of GDM may reduce peripartum risk, but there is a lack of consensus on how to define, screen and treat GDM.\\u000a There is

Assiamira Ferrara; Catherine Kim

60

Maternal Gestational Diabetes, Birth Weight, and Adolescent Obesity  

Microsoft Academic Search

Objective. Obesity increases risk of many adverse outcomes, but its early origins are obscure. Gestational diabetes mellitus (GDM) reflects a metabol- ically altered fetal environment associated with high birth weight, itself associated with later obesity. Previous studies of GDM and offspring obesity, however, have been few and conflicting. The objectives of this study were to examine associations of birth weight

Matthew W. Gillman; Sheryl Rifas-Shiman; Catherine S. Berkey; Alison E. Field; Graham A. Colditz

61

Pharmacogenomic assessment of treatment options in gestational diabetes  

Microsoft Academic Search

Gene expression profiles offer a multidimensional view of metabolic diseases, typically characterized by a single parameter, and can provide a basis for choosing between therapies yielding a common clinical end point. We applied such an approach in gestational diabetes mellitus (GDM). Gene expression was examined in four maternal tissues and placentas from normal patients and euglycemic GDM patients, undergoing elective

T Ort; M Voss; A Lichtmacher; M Saidel; M DeFrancesco; P Greenberg; B Hunt; A Eisen

2005-01-01

62

Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes  

Microsoft Academic Search

Objectives: To study prevalence, risk factors, and maternal and infant outcomes of women with gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was performed based on 111563 pregnancies delivered between 1991 through 1997 in 39 hospitals in northern and central Alberta, Canada. Multivariate logistic regression was used to estimate the odds ratios with 95% confidence intervals, and to control

X. Xiong; L. D. Saunders; F. L. Wang; N. N. Demianczuk

2001-01-01

63

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus  

Microsoft Academic Search

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in

Sue Levkoff; Alison Stuebe; Ellen W Seely; Rhonda Bentley-Lewis

2008-01-01

64

[Gestational diabetes--perinatal hyperinsulinism and postnatal developmental disorders].  

PubMed

The impaired glucose tolerance in pregnancy (IGT) represents an important fact in aetiopathogenesis of insulin dependent diabetes mellitus (IDDM) and non insulin dependent diabetes (NIDDM) as well as obesitas and cardiovascular diseases in context with fetal hyperinsulinism. Prospective studies of diabetic mothers newborns are difficult by reason of health controls in different outpatient departments. The aim of this review is to claim a general glucose screening in pregnancy looking on the development of newborns in later life. In present preventive prospects were not used to decrease the morbidity in diabetes, obesitas and cardiovascular diseases without gestational diabetes screening in pregnancy. The neonatal onset and late morbidity is dependent on the quality of maternal glycemia in pregnancy measured by means of glycosylated hemoglobin and insulin the amniotic fluid. PMID:9340971

Briese, V; Stiete, H; Stiete, S

1997-01-01

65

A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes  

PubMed Central

BACKGROUND It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes. METHODS Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e., an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [5.3 mmol per liter]) were randomly assigned to usual prenatal care (control group) or dietary intervention, self-monitoring of blood glucose, and insulin therapy, if necessary (treatment group). The primary outcome was a composite of stillbirth or perinatal death and neonatal complications, including hyperbilirubinemia, hypoglycemia, hyperinsulinemia, and birth trauma. RESULTS A total of 958 women were randomly assigned to a study group — 485 to the treatment group and 473 to the control group. We observed no significant difference between groups in the frequency of the composite outcome (32.4% and 37.0% in the treatment and control groups, respectively; P = 0.14). There were no perinatal deaths. However, there were significant reductions with treatment as compared with usual care in several prespecified secondary outcomes, including mean birth weight (3302 vs. 3408 g), neonatal fat mass (427 vs. 464 g), the frequency of large-for-gestational-age infants (7.1% vs. 14.5%), birth weight greater than 4000 g (5.9% vs. 14.3%), shoulder dystocia (1.5% vs. 4.0%), and cesarean delivery (26.9% vs. 33.8%). Treatment of gestational diabetes mellitus, as compared with usual care, was also associated with reduced rates of preeclampsia and gestational hypertension (combined rates for the two conditions, 8.6% vs. 13.6%; P = 0.01). CONCLUSIONS Although treatment of mild gestational diabetes mellitus did not significantly reduce the frequency of a composite outcome that included stillbirth or perinatal death and several neonatal complications, it did reduce the risks of fetal overgrowth, shoulder dystocia, cesarean delivery, and hypertensive disorders.

Landon, Mark B.; Spong, Catherine Y.; Thom, Elizabeth; Carpenter, Marshall W.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Lain, Kristine Y.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.; Anderson, Garland B.

2009-01-01

66

Neonatal Hyperthyrotropinemia in Gestational Diabetes mellitus and Perinatal Complications  

Microsoft Academic Search

The aim of this study is to explore the relationship between high cord blood thyroid-stimulating hormone (TSH) level and in-utero stress to the fetus in gestational diabetes mellitus (GDM). Cord blood TSH results were analyzed in 1,578 euthyroid infants from singleton pregnancies with GDM: 103 with elevated TSH (>16 mIU\\/l) and 1,475 with normal TSH. Maternal characteristics, pregnancy outcome and

Wing Cheong Leung; Karen K. L. Chan; Terence T. Lao

2004-01-01

67

Asymmetric dimethylarginine concentrations are elevated in women with gestational diabetes  

Microsoft Academic Search

As shown in the previous studies, asymmetric dimethylarginine (ADMA) is related to endothelial dysfunction, whereas high-sensitive\\u000a C-reactive protein (hCRP) is the marker of inflammation. In our study, we investigated ADMA, hCRP, and homocysteine concentrations\\u000a in women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) during late pregnancy. Fifty-four women\\u000a with GDM and 69 women with NGT between 32

Mujde Akturk; Alev Altinova; Ismail Mert; Aylin Dincel; Ayla Sargin; Umran Buyukkagnici; Metin Arslan; Nuri Danisman

2010-01-01

68

Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women  

Microsoft Academic Search

We examined antepartum clinical characteristics along with measures of glucose tolerance, insulin sensitivity, pancreatic -cell function, and body composition in Latino women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes or impaired glucose tolerance (IGT) within 6 months after delivery. A total of 122 islet cell antibody-negative women under- went oral and intravenous glucose tolerance

Thomas A. Buchanan; Anny Xiang; Siri L. Kjos; W. P. Lee; Enrique Trigo; Isabel Nader; E. Anne Bergner; Jerry P. Palmer; Ruth K. Peters

1998-01-01

69

Approach to the Patient with Gestational Diabetes after Delivery  

PubMed Central

The diagnosis of gestational diabetes mellitus (GDM) identifies patients with a pancreatic ?-cell defect. In some patients, the defect is transient or stable, but in most it is progressive, imparting a high risk of diabetes for at least a decade after the index pregnancy. The ?-cell defects in GDM can result from many causes, including genetic variants typical of monogenic forms of diabetes and autoimmunity typical of evolving type 1 diabetes. No specific disease-modifying therapies are available for those patients. The majority of women with GDM have clinical characteristics indicating a risk for type 2 diabetes (T2D). Available evidence indicates that T2D can be prevented or delayed by intensive lifestyle modification and by medications, particularly those that ameliorate insulin resistance. Clinical management should include assessment of glucose tolerance in the postpartum period to detect diabetes or assess diabetes risk. Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. All patients should be monitored for rising glycemia indicative of progressive ?-cell deterioration. We suggest a combination of fasting glucose and glycosylated hemoglobin measurements for this purpose. Monitoring should be initiated at least annually and should be intensified if glycemia is rising and/or impaired. Lifestyle modification is advised to reduce the risk for T2D. Like monitoring, lifestyle modification should be intensified for rising glycemia and/or development of impaired glucose levels. At present, there is insufficient evidence to recommend medications to prevent T2D. Close follow-up and monitoring will allow initiation of pharmacological treatment as soon as diabetes develops. Children of women with GDM are at increased risk for obesity and diabetes. They should receive education, monitoring, and lifestyle advice to minimize obesity and diabetes risk.

Page, Kathleen A.

2011-01-01

70

Approach to the patient with gestational diabetes after delivery.  

PubMed

The diagnosis of gestational diabetes mellitus (GDM) identifies patients with a pancreatic ?-cell defect. In some patients, the defect is transient or stable, but in most it is progressive, imparting a high risk of diabetes for at least a decade after the index pregnancy. The ?-cell defects in GDM can result from many causes, including genetic variants typical of monogenic forms of diabetes and autoimmunity typical of evolving type 1 diabetes. No specific disease-modifying therapies are available for those patients. The majority of women with GDM have clinical characteristics indicating a risk for type 2 diabetes (T2D). Available evidence indicates that T2D can be prevented or delayed by intensive lifestyle modification and by medications, particularly those that ameliorate insulin resistance. Clinical management should include assessment of glucose tolerance in the postpartum period to detect diabetes or assess diabetes risk. Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. All patients should be monitored for rising glycemia indicative of progressive ?-cell deterioration. We suggest a combination of fasting glucose and glycosylated hemoglobin measurements for this purpose. Monitoring should be initiated at least annually and should be intensified if glycemia is rising and/or impaired. Lifestyle modification is advised to reduce the risk for T2D. Like monitoring, lifestyle modification should be intensified for rising glycemia and/or development of impaired glucose levels. At present, there is insufficient evidence to recommend medications to prevent T2D. Close follow-up and monitoring will allow initiation of pharmacological treatment as soon as diabetes develops. Children of women with GDM are at increased risk for obesity and diabetes. They should receive education, monitoring, and lifestyle advice to minimize obesity and diabetes risk. PMID:22143829

Buchanan, Thomas A; Page, Kathleen A

2011-12-01

71

Gestational diabetes mellitus: risks and management during and after pregnancy.  

PubMed

Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341

Buchanan, Thomas A; Xiang, Anny H; Page, Kathleen A

2012-07-03

72

Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women  

Microsoft Academic Search

An increasing number of patients from different ethnic groups is admitted to European diabetes treatment centers. Counseling programs are of central importance in disease treatment, especially in gestational diabetes where counseling is of influence also on the outcome of pregnancy. We report about the outcome of gestational diabetes in 39 Mediterranean Turkish and 72 Caucasian Austrian women treated at our

Friedrich Hoppichler; Monika Lechleitner

2001-01-01

73

Diagnostic Controversy: Gestational Diabetes and the Meaning of Risk for Pima Indian Women  

Microsoft Academic Search

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

Carolyn M. Smith-Morris

2005-01-01

74

Avoiding the slippery slope: preventing the development of diabetes in women with a history of gestational diabetes.  

PubMed

Women with a history of gestational diabetes are at increased risk of developing type 2 diabetes. By identifying this high-risk group who has not yet developed the disease, we have the opportunity to try to prevent this progression to diabetes. In this article, we review the evidence for different strategies used to prevent the onset of diabetes in women with a history of gestational diabetes. These strategies include lifestyle changes, medications and breastfeeding. PMID:22228687

Feig, Denice S

2012-05-01

75

A3-4: Recreational Physical Activity and Gestational Weight Gain in Women with Gestational Diabetes  

PubMed Central

Background/Aims Excess gestational weight gain (GWG) is associated with several adverse perinatal outcomes, including increased infant size at birth and postpartum weight retention. These outcomes are particularly problematic for women with gestational diabetes (GDM), who are already at risk for delivering a large infant and developing type 2 diabetes later in life. Participation in recreational physical activity during pregnancy may mitigate excess GWG, but the association has not been previously examined in a large cohort of women with GDM. Methods This study utilized baseline data from a clustered randomized intervention trial (Gestational Diabetes Effects on Moms – the GEM study) conducted at Kaiser Permanente Northern California (KPNC) to estimate the association between participation in recreational physical activity and GWG among women with GDM. Women with multiple fetuses and those on bed rest were excluded, leaving a final analytic cohort of 790 women. Recreational physical activity (walking quickly for fun or exercise, jogging, exercise classes, swimming, dancing, yoga, pilates, weight lifting/resistance exercises and team sports) in the past 3 months was assessed using the Pregnancy Physical Activity Questionnaire (PPAQ). Data on gestational weight gain per week (kg) up until the time of the oral glucose tolerance test (OGTT) was abstracted from the electronic medical record. Results Compared to those who reported not participating in any recreational physical activity, women who reported participating in some recreational physical activity had a significantly reduced risk of GWG in the upper quartile [GWG >0.39 kg (0.85 lb.) per week]; this association was independent of age, prepregnancy body mass index (BMI), race-ethnicity, and parity [OR = 0.63 (95% CI 0.41–0.97)]. In sensitivity analyses limited to women who completed the PPAQ within 6 weeks (n = 448) and 4 weeks (n = 234) of the OGTT, the associations were more pronounced [OR = 0.42 (95% CI 0.24–0.72) and OR = 0.28 (95% CI 0.12–0.63), respectively]. No dose-response relationship was observed between high (>1.07 MET hours per day) and low (? 1.07 MET hours per day) recreational physical activity. Conclusions Participation in recreational physical activity during pregnancy may mitigate high GWG in women with GDM.

Ehrlich, Samantha; Sternfeld, Barbara; Hu, Kirsten Unger; Hedderson, Monique; Mevi, Ashley; Brown, Susan; Kubo, Ai; Ferrara, Assiamira

2013-01-01

76

A3-4: recreational physical activity and gestational weight gain in women with gestational diabetes.  

PubMed

Background/Aims Excess gestational weight gain (GWG) is associated with several adverse perinatal outcomes, including increased infant size at birth and postpartum weight retention. These outcomes are particularly problematic for women with gestational diabetes (GDM), who are already at risk for delivering a large infant and developing type 2 diabetes later in life. Participation in recreational physical activity during pregnancy may mitigate excess GWG, but the association has not been previously examined in a large cohort of women with GDM. Methods This study utilized baseline data from a clustered randomized intervention trial (Gestational Diabetes Effects on Moms - the GEM study) conducted at Kaiser Permanente Northern California (KPNC) to estimate the association between participation in recreational physical activity and GWG among women with GDM. Women with multiple fetuses and those on bed rest were excluded, leaving a final analytic cohort of 790 women. Recreational physical activity (walking quickly for fun or exercise, jogging, exercise classes, swimming, dancing, yoga, pilates, weight lifting/resistance exercises and team sports) in the past 3 months was assessed using the Pregnancy Physical Activity Questionnaire (PPAQ). Data on gestational weight gain per week (kg) up until the time of the oral glucose tolerance test (OGTT) was abstracted from the electronic medical record. Results Compared to those who reported not participating in any recreational physical activity, women who reported participating in some recreational physical activity had a significantly reduced risk of GWG in the upper quartile [GWG >0.39 kg (0.85 lb.) per week]; this association was independent of age, prepregnancy body mass index (BMI), race-ethnicity, and parity [OR = 0.63 (95% CI 0.41-0.97)]. In sensitivity analyses limited to women who completed the PPAQ within 6 weeks (n = 448) and 4 weeks (n = 234) of the OGTT, the associations were more pronounced [OR = 0.42 (95% CI 0.24-0.72) and OR = 0.28 (95% CI 0.12-0.63), respectively]. No dose-response relationship was observed between high (>1.07 MET hours per day) and low (? 1.07 MET hours per day) recreational physical activity. Conclusions Participation in recreational physical activity during pregnancy may mitigate high GWG in women with GDM. PMID:24086008

Ehrlich, Samantha; Sternfeld, Barbara; Hu, Kirsten Unger; Hedderson, Monique; Mevi, Ashley; Brown, Susan; Kubo, Ai; Ferrara, Assiamira

2013-09-01

77

Prolactin and lactation as modifiers of diabetes risk in gestational diabetes.  

PubMed

Pregnancy and puerperium are periods of intense hormonal changes. Maternal metabolism adapts to spare the mother from harm on behalf of her developing offspring and major alterations maintain normal glucose tolerance. Insulin secretion increases during a normal pregnancy to compensate for pregnancy-induced insulin resistance and maintain euglycemia. Women at risk for gestational diabetes have insulin resistance before conception. Gestational diabetes develops when a woman at risk is unable to meet the insulin secretory demands imposed by the additional insulin resistance characteristic of pregnancy. The lactogens, human placental lactogen and prolactin, are major stimuli for the adaptation of the endocrine pancreas during gestation. This review discusses the role of lactogens on glucose homeostasis during pregnancy and proposes a mechanism by which the hormonal control of lactation, led by prolactin, may regulate adipocyte biology, glucose and lipid metabolism, and guard postpartum women against type 2 diabetes. PMID:21823053

Ramos-Román, M A

2011-08-05

78

Gestational diabetes, pregnancy hypertension, and late vascular disease.  

PubMed

The complexity of the several pathogenic pathways that cause hypertension and vascular disease and the prolonged interval that appears to predate clinical morbidity have hindered inquiry into the association between GDM and vascular disorders. As a forme fruste of later type 2 diabetes, GDM-affected gravidas are identified as at risk of diabetes-related atherosclerosis, glomerular disruption, and pathogenic retinal angio-genesis. That GDM is evidence for underlying chronic conditions such as dysregulation of innate immune response that, independent of the diabetic state, produces vascular disease is difficult state, produces vascular disease is difficult to assert with the present published literature. Cross-sectional studies of patients with established gestational hypertension or preeclampsia are ambiguous as to the possible pathogenic effect of insulin resistance. Cohort studies initiated in early and mid-pregnancy show evidence that both gestational hypertension and preeclampsia may be more prevalent in gravidas with greater insulin resistance. The association of gestational glucose intolerance with gestational hypertension appears to be independent of obesity and ambient glycemia but explained in part by insulin resistance. Late pregnancy preeclampsia is associated with elevated mid-pregnancy BMI, blood pressure, fasting glucose and insulin, urate, and C-reactive protein, suggestive of metabolic and immune dysregulation. GDM appears to be associated with overexpressed innate immune response, which, in turn, is associated with vascular dysfunction and vascular disease. Among women with GDM, markers of insulin resistance do not appear to correlate with hypertension in short-term cohort studies. However, when non-GDM subjects are compared with subjects with GDM, postpregnancy studies do show an associated with vascular dysfunction and vascular disease. Among women with GDM, markers of insulin resistance do not appear to correlate with hypertension in short-term cohort studies. However, when non-GDM subjects are compared with subjects with GDM, postpregnancy studies do show an association of insulin resistance with both inflammatory dysregulation and vascular dysfunction. Cohort studies that have used population-based pregnancy databases consistently identify a clinically significant association of both gestational hypertension and preeclampsia with later hypertensive disorders. Associations with coronary artery disease or stroke are less consistent, requiring further investigation. Preventing the evolution of diabetes and lipid and immune dysregulation of the metabolic syndrome has become a silent public health issue because of the epidemic of childhood and early adulthood obesity and the opportunity at hand to treat insulin resistance by behavioral and pharmacological interventions. However, limited available literature highlights the need for long-term cohort studies of women with well-characterized metabolic and vascular profiles during pregnancy and decades later. Our present knowledge suggests that screening for GDM provides an opportunity of pregnancy outcome improvement. Limited studies of diabetes prevention in at-risk patient groups suggest that we may have the opportunity to reduce the risk of later diabetes. Additional investigation is required to determine if interventions that prevent or postpone diabetes also delay the onset of vascular disease. PMID:17596480

Carpenter, Marshall W

2007-07-01

79

Insulin analogues in the treatment of gestational diabetes mellitus.  

PubMed

Rapid-acting insulin analogues are the preferred choice for short-acting insulin due to their superior pharmacologic profiles, leading to greater flexibility and convenience of dosing. This has lead to greater patient satisfaction and improved quality of life. Clinical experience with rapid-acting insulin analogues in pregnancy is increasing. Currently, there is limited data available on the use of long-acting insulin analogues in pregnancy. The focus of this review is to discuss the role of insulin analogue therapy in the treatment of the woman with gestational diabetes. PMID:24022504

Durnwald, Celeste P

2013-12-01

80

Oral agents for the management of gestational diabetes.  

PubMed

In gestational diabetes (GDM), achieving euglycemia through treatment decreases the risk of adverse outcomes associated with hyperglycemia. Treatment starts with diet and nutritional counseling; however, up to 50% of women will require pharmacologic therapy to meet glucose goals. Although insulin remains the only Federal Drug Administration-approved agent to treat GDM, oral hypoglycemic agents are an attractive and increasingly common alternative. Research suggests that glyburide and metformin can each effectively manage hyperglycemia in pregnancy. This review highlights research on efficacy, safety, and advantages versus disadvantages of each. We offer management and counseling strategies for clinicians caring for patients with GDM. PMID:24005130

Berggren, Erica K; Boggess, Kim A

2013-12-01

81

Total plasma homocysteine correlates in women with gestational diabetes  

Microsoft Academic Search

Aim  We aim to assess serum total homocysteine (tHcy) associations with metabolic syndrome components and B-vitamins in women with\\u000a gestational diabetes mellitus (GDM).\\u000a \\u000a \\u000a \\u000a Methods  We studied 61 consecutive pregnant women, 44 with GDM and 17 with normal glucose tolerance (CG). Serum homocysteine levels\\u000a were analyzed by ELISA, using Bio-Rad reagents. Serum folates and vitamin B12 concentrations were determined by chemiluminescent immunoassay, free

B. Idzior-Walu?; K. Cyganek; K. Sztefko; G. Seghieri; M. C. Breschi; M. Walu?-Miarka; E. Kawalec; M. Seretny; J. Sieradzki

2008-01-01

82

The Association Between Gestational Diabetes Mellitus and Recreational Physical Activity  

Microsoft Academic Search

We aimed to investigate the association of recreational physical activity before pregnancy with gestational diabetes mellitus\\u000a (GDM). A cross-sectional study was performed using self-reported data from the Pregnancy Risk Assessment and Monitoring System.\\u000a The study population included 1,052 self-reported GDM cases and 10,351 non-GDM controls. Recreational physical activity in\\u000a the 3 months before pregnancy was recalled in postpartum structured interviews. Compared

Stephanie L. Redden; Michael J. LaMonte; Jo L. Freudenheim; Carole B. Rudra

2011-01-01

83

Vitamin D Deficiency in Pregnancy and Gestational Diabetes  

PubMed Central

Objective We examined the association of second trimester maternal plasma 25-hydroxyvitamin D (25[OH]D) during pregnancy with gestational diabetes mellitus(GDM). Study Design Among 1314 pregnant women participating in Project Viva, a birth cohort study, we measured 25(OH)D levels at 26–28 weeks’ gestation during GDM screening using a 1-hour 50g glucose challenge test. Results We found 25(OH)D levels <25nmol/L in 44/1087(4.0%) women with normal glucose tolerance, 9/159(5.7%) women with impaired glucose tolerance and 9/68(13.2%) women with GDM. Analyses adjusted for sociodemographics, season, maternal BMI, gestational weight gain and dietary factors, suggested that women with 25(OH)D levels <25 vs. ?25 nmol/L may have higher odds of GDM (2.2 [0.8, 5.5]). Glucose levels after the glucose challenge test were inversely associated with 25(OH)D levels(P <0.01). Conclusion Second trimester 25(OH)D levels were inversely associated with glucose levels after 1-hour 50g glucose challenge test and low 25(OH)D levels may be associated with increased risk of GDM.

Burris, Heather H; Rifas-Shiman, Ms. Sheryl L.; Kleinman, Ken; Litonjua, Augusto A.; Huh, Susanna Y.; Rich-Edwards, Janet W.; Camargo, Carlos A.; Gillman, Matthew W.

2012-01-01

84

Gestational diabetes mellitus and subsequent development of overt diabetes mellitus.  

PubMed

GDM develops in 1-3% of all pregnancies. Women with GDM are characterized by a relatively diminished insulin secretion coupled with a pregnancy-induced insulin resistance primary located in skeletal muscle tissue. The cellular background for this insulin resistance is not known. The binding of insulin to its receptor and the subsequent activation of the insulin receptor tyrosine kinase have significant importance for the cellular effect of insulin. Thus, the pathogenesis to the insulin resistance was studied by investigating insulin receptor binding and tyrosine kinase activity in skeletal muscle biopsies from women with GDM and pregnant controls. No major abnormalities were found in GDM wherefore it is likely that the insulin resistance is caused by intracellular defects distal to the activation of the tyrosine kinase. Glucose tolerance returns to normal postpartum in the majority of women with GDM. However, previous studies, in populations quite different from a Danish population, have shown that women with previous GDM have a high risk of developing overt diabetes mellitus later in life. Hence, we aimed to investigate the prognosis of women with previous GDM with respect to subsequent development of diabetes and also to identify predictive factors for the development of overt diabets in these women. A follow-up study of diet treated GDM women diagnosed during 1978 to 1985 at the Rigshospital, Copenhagen was performed. Glucose tolerance was evaluated in 241 women (81% of the GDM population) 2-11 years after pregnancy. Abnormal glucose tolerance was found in 34.4% of the women (3.7% IDDM, 13.7% NIDDM, 17% IGT) in contrast to a control group where none had diabetes and 5.3% had IGT. Logistic regression analysis identified the following independent risk factors for later development of diabetes: a high fasting glucose level at diagnosis of GDM, a delivery more than 3 weeks before term, and an abnormal OGTT 2 months postpartum. Low insulin secretion at diagnosis of GDM was also an independent risk factor. The presence of ICA and GAD-autoantibodies in pregnancy was associated with later development of IDDM. In another study the following techniques: hyperinsulinaemic euglycaemic clamp, indirect calorimetry and tritiated glucose infusion were used to evaluate insulin sensitivity in glucose tolerant nonobese women with previous GDM and controls. A decreased insulin sensitivity due to a decreased non-oxidative glucose metabolism in skeletal muscle was found in women with previous GDM. Hence, the activity of three key enzymes in intracellular glucose metabolism (GS, HK and PFK) was studied in skeletal muscle biopsies obtained in the basal state and after 3 h hyperinsulinaemia, with the aim to identify the cellular defects causing the decreased insulin sensitivity. However, no abnormalities in enzyme activity was found. The same group of previous GDM women had a relatively reduced insulin secretion evaluated by the IVGTT. A longitudinal study of 91 GDM women showed a relatively reduced insulin secretion to oral glucose in pregnancy, postpartum as well as 5-11 years later. Thus the present review has shown that even nonobese glucose tolerant women with previous GDM are characterized by the metabolic profile of NIDDM i.e. insulin resistance and impaired insulin secretion. Hence, the combination of this finding together with the significantly increased risk for development of diabetes indicates that all women with previous GDM should have a regular assessment of their glucose tolerance in the years after pregnancy. The first OGTT should be performed around 2 months postpartum in order to diagnose women already diabetic and to identify women with the highest risk for later development of overt diabetes. Women with previous GDM comprise a target group for future intervention trials with the aim to prevent or delay development of NIDDM and IDDM. PMID:9850811

Damm, P

1998-11-01

85

Overweight and obesity in infants of mothers with long-term insulin-dependent diabetes or gestational diabetes  

Microsoft Academic Search

OBJECTIVES: To analyse the development of body weight and frequencies of overweight and obesity in infants of long-term insulin-dependent diabetic mothers as compared to those of gestational diabetic mothers. DESIGN: Retrospective study. SUBJECTS: Two hundred infants of mothers with pregestational insulin-dependent diabetes mellitus (IDM) and 117 infants of gestational diabetic mothers (IGDM) born between 1980 and 1990 at the Clinic

A Plagemann; T Harder; R Kohlhoff; W Rohde; G Dörner

1997-01-01

86

Staphylococcal Sepsis with Multiple Abscesses, Urinary Tract Infection, and Bilateral Renal Vein Thrombosis in a Patient with Uncontrolled Diabetes Mellitus  

PubMed Central

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

Khan, Malik A. A.; Hunter, Jonathan Michael; Tan, Christopher; Seleem, Mostafa; Stride, Peter J. O.

2012-01-01

87

Elevated Lipoprotein Lipids and Gestational Hormones in Women With Diet-Treated Gestational Diabetes Mellitus Compared to Healthy Pregnant Controls  

Microsoft Academic Search

The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and\\/or glucose control. Maternal HbA1c, free fatty acids (FFA), ?-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol,

Sarah C Couch; Elliot H Philipson; Robert B Bendel; Lillian M Pujda; Robert A Milvae; Carol J Lammi-Keefe

1998-01-01

88

Selective versus Universal Screening for Gestational Diabetes Mellitus: An Evaluation of Naylor’s Model  

Microsoft Academic Search

Aim: Selective screening for gestational diabetes is still a subject of debate. The aim of this study was to determine the effectiveness of a selective screening strategy for diagnosing gestational diabetes in our setting. This strategy rests on a scoring system that assigns women to different risk categories according to the presence of risk factors such as overweight, older age

Anne-Frédérique Minsart; Jean-Paul Lescrainier; Alain Vokaer

2009-01-01

89

Glucose Tolerance and Risk of Gestational Diabetes Mellitus in Nulliparous Women Who Smoke during Pregnancy  

Microsoft Academic Search

Gestational diabetes mellitus has been associated with adverse maternal and infant outcomes, including preeclampsia and fetal macrosomia. Although cigarette smoking has been associated with increased insulin resistance, its effect on gestational diabetes mellitus risk is uncertain. The authors evaluated the effects of smoking on glucose tolerance in a cohort of pregnant women who participated in the Calcium for Preeclampsia Prevention

Lucinda J. England; Richard J. Levine; Cong Qian; Lisa M. Soule; Enrique F. Schisterman; Kai F. Yu; Patrick M. Catalano

90

Migrant Health: A Preliminary Report on the Incidence of Gestational Diabetes in a Hispanic Migrant Population.  

ERIC Educational Resources Information Center

|Presents the preliminary results of an attempt to screen pregnant Hispanic migrant farm workers for gestational diabetes. They are slightly more prone than the overall population of pregnant women to suffer from it. Provides recommendations for management of women with gestational diabetes, and describes how this is performed at the Indian Health…

O'Donnell, Patrick J.

1987-01-01

91

Migrant Health: A Preliminary Report on the Incidence of Gestational Diabetes in a Hispanic Migrant Population.  

ERIC Educational Resources Information Center

Presents the preliminary results of an attempt to screen pregnant Hispanic migrant farm workers for gestational diabetes. They are slightly more prone than the overall population of pregnant women to suffer from it. Provides recommendations for management of women with gestational diabetes, and describes how this is performed at the Indian Health…

O'Donnell, Patrick J.

1987-01-01

92

Diagnosis of gestational diabetes mellitus in Asian-Indian women  

PubMed Central

Objective: To assess the validity of Diabetes in Pregnancy Study Group India (DIPSI) guidelines, a modified version of the WHO criterion to diagnose gestational diabetes mellitus (GDM). Materials and Methods: A total of 1 463 consecutive pregnant women in the second and third trimester of pregnancy underwent 75 g oral glucose tolerance test (OGTT) and 2-h plasma glucose (PG) was measured by the glucose oxidase-peroxidase (GOD-POD) method. GDM was diagnosed with 2-h PG ? 7.8 mmol/L (WHO criteria) and the rest were classified as normal glucose tolerant (NGT) women. GDM women were advised medical nutrition therapy (MNT) for two weeks. Those who failed to reach the target glycemic level of FPG < 5.0 mmol/L and 2-h PG < 6.67 mmol/L with MNT were advised insulin. All of them were followed throughout pregnancy until delivery. Birth weight of 90th percentile (> 3.45 kg) in the neonates was considered as macrosomia (primary outcome). Results: The mean maternal age and body mass index were 23.60±3.32 years and 21.5±4.06 kg/m2 respectively. The mean gestational age was 27.9±5.56 weeks. DIPSI criterion identified 196 women (13.4%) as GDM and the rest as NGT. Insulin was required in 19 (9.7%) women with GDM. Macrosomia was observed in 9.9% GDM women with intervention and 9.8% in NGT (P = 1.000). Conclusion: DIPSI criterion is a one step-cost effective and evidence-based procedure to diagnose GDM in any socio-economic setting.

Balaji, V.; Balaji, Madhuri; Anjalakshi, C.; Cynthia, A.; Arthi, T.; Seshiah, V.

2011-01-01

93

Role of patient education level in predicting macrosomia among women with gestational diabetes mellitus  

Microsoft Academic Search

Objective:To evaluate the role of education level in predicting the risk of macrosomia among women with gestational diabetes mellitus.Study design:Women with gestational diabetes, who were referred to the California Diabetes and Pregnancy Sweet Success Program between June 2001 and December 2002, were included in the study. Multiple logistic regression was used estimate the risk of macrosomia, defined as a birth

J H Chung; K J Voss; A B Caughey; D A Wing; E J D Henderson; C A Major

2006-01-01

94

Glucokinase gene in gestational diabetes mellitus: population association study and molecular scanning.  

PubMed

Mutations of the glucokinase gene result in early-onset familial Type 2 (non-insulin-dependent) diabetes mellitus, and several members of the mutant glucokinase kindreds were originally diagnosed as having gestational diabetes. This study examined the glucokinase gene in 270 American Black women, including 94 with gestational diabetes whose diabetes resolved after pregnancy (gestational diabetes only), 77 with gestational diabetes who developed Type 2 diabetes after pregnancy (overt diabetes), and 99 normal control subjects who were recruited during the peripartum period. Two simple sequence repeat polymorphisms flanking either end of the glucokinase gene were evaluated. No association was found between glucokinase alleles and gestational diabetes only or overt diabetes, after adjustment for multiple comparisons. To detect single base changes, all 11 exons and proximal islet and liver promoter regions were examined by polymerase chain reaction plus single-stranded conformational polymorphism analysis in 45 gestational diabetes only patients who had not yet developed Type 2 diabetes. Nine coding region variants were identified: Ala11 (GCC) to Thr11 (ACC) in islet exon 1, and 8 variants either in untranslated regions or in the third base of a codon. Four variant sites were found in introns, but none in splicing consensus sequences. Analysis of the promoter regions revealed two common variants, G-->A at islet -30 (24%), and G-->A at liver -258 (42%). The frequencies of the promoter variants, determined by allele specific polymerase chain reaction analysis, but did not differ among the three groups. Thus, no significant coding sequence glucokinase mutations were found in 90 alleles from 45 patients with gestational diabetes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8150222

Chiu, K C; Go, R C; Aoki, M; Riggs, A C; Tanizawa, Y; Acton, R T; Bell, D S; Goldenberg, R L; Roseman, J M; Permutt, M A

1994-01-01

95

High Priority Research Needs for Gestational Diabetes Mellitus  

PubMed Central

Abstract Objective Identification of unanswered research questions about the management of gestational diabetes mellitus (GDM) is necessary to focus future research endeavors. We developed a process for elucidating the highest priority research questions on GDM. Methods Using a systematic review on GDM as a starting point, we developed an eight-step process: (1) identification of research gaps, (2) feedback from the review's authors, (3) translation of gaps into researchable questions using population, intervention, comparators, outcomes, setting (PICOS) framework, (4) local institutions' stakeholders' refinement of research questions, (5) national stakeholders' use of Delphi method to develop consensus on the importance of research questions, (6) prioritization of outcomes, (7) conceptual framework, and (8) evaluation. Results We identified 15 high priority research questions for GDM. The research questions focused on medication management of GDM (e.g., various oral agents vs. insulin), delivery management for women with GDM (e.g., induction vs. expectant management), and identification of risk factors for, prevention of, and screening for type 2 diabetes in women with prior GDM. Stakeholders rated the development of chronic diseases in offspring, cesarean delivery, and birth trauma as high priority outcomes to measure in future studies. Conclusions We developed an eight-step process using a multidisciplinary group of stakeholders to identify 15 research questions of high clinical importance. Researchers, policymakers, and funders can use this list to direct research efforts and resources to the highest priority areas to improve care for women with GDM.

Robinson, Karen A.; Saldanha, Ian J.; Wilson, Lisa M.; Nicholson, Wanda K.

2012-01-01

96

Interconception care for women with prior gestational diabetes mellitus.  

PubMed

The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long-term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged. PMID:23631462

Mielke, Ruth T; Kaiser, Deborah; Centuolo, Rhonda

2013-04-30

97

Gestational diabetes mellitus: Get, set, go From diabetes capital of the world to diabetes care capital of the world  

PubMed Central

Screening and diagnosis for gestational diabetes mellitus (GDM) as well as interventions for its management evoke considerable controversy. There are different types of screening methods: universal or risk-based, one step or two step. Different thresholds for diagnosis of GDM have been in vogue. Previous definition and diagnostic criteria had no place for diagnosis of overt diabetes in pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, new screening and diagnostic criteria around the world seem to be gaining consensus. The present recommendation given by IADPSG for screening and diagnosis of diabetes mellitus in pregnancy has two discrete phases. The first is detection of women with overt diabetes not previously diagnosed or treated outside of pregnancy. Universal early testing in populations is recommended at the first prenatal visit. The second phase is a 75-g OGTT at 24–28 week gestation in all women not previously found to have overt diabetes or GDM. ACHOIS and MFMU Network trails have proven benefit in treating hyperglycemias less than what is diagnostic for diabetes. DIPSI has shown the alternative way for resource-challenged communities. Efforts from all stake holders with interest in GDM are required to make the diabetes capital of the world into the diabetes care capital of the world.

Magon, Navneet

2011-01-01

98

Inflammatory mediator gene polymorphisms and gestational diabetes: a review of the literature  

Microsoft Academic Search

The incidence of gestational diabetes (GD) is rising worldwide, in parallel with obesity and type 2 diabetes. Obesity and GD are conditions that have in common a state of chronic, low-grade subclinical inflammation characterized by abnormal production of cytokines and mediators. Genetic polymorphisms may influence the production of inflammatory mediators and predispose to different disorders, including diabetes. The aim of

Silvia Daher; Maria Regina Torloni; Barbara Yasmin Gueuvoghlanian-Silva; Antonio Fernandes Moron; Rosiane Mattar

2011-01-01

99

Impact of Gestational Diabetes Mellitus Nutrition Practice Guidelines Implemented by Registered Dietitians on Pregnancy Outcomes  

Microsoft Academic Search

Nutrition practice guidelines were developed for gestational diabetes mellitus by registered dietitians from the Diabetes Care and Education and the Women’s Health and Reproductive Nutrition dietetic practice groups. To validate the guidelines, a clinical trial was designed with clinic sites randomly assigned to either nutrition practice guidelines care (12 sites) or usual nutrition care (13 sites), with diabetes, obstetric, and

Diane Reader; Patricia Splett; Erica P. Gunderson

2006-01-01

100

Screening for gestational diabetes by measuring fasting plasma glucose levels  

PubMed Central

Objectives: (a) To test the sensitivity and specificity of measuring fasting plasma glucose levels (FPG) as a screening test for gestational diabetes mellitus (GDM). (b) To compare predicting levels of FPG levels with the one-hour, oral 50g non-fasting glucose challenge test (GCT) for predicting GDM. Methods: One thousand and six hundred pregnant women from the Health Centres, antenatal clinics and Salmaniya Medical Complex were screened by the GCT after 50g of oral glucose during 26–32 weeks gestation, giving a 13.5% incidence of GDM (using the Third International Workshop cutoff values of 7.8 mmol /l). All patients also had an FPG estimation followed by the three-hour oral glucose tolerance test (oGTT). Seventy eight percent of the patients were Bahraini, 19% Asian and 3% other nationalities. Their mean age was 27.2+0.2 years. Receiver-operating curves (ROC) were used to test the ability of the FPG and the oGTT to differentiate patients with GDM and identify the cut off values for predicting a diagnosis of GDM. Results: FPG levels of 5.6 mmol /l and 5.4 mmol /l yielded sensitivities and specificities of 94% and 93% respectively. Measuring FPG as a screening test required a diagnostic oGTT in 32% compared with 13% when the GCT was used. Conclusion: Using FPG levels at a cutoff value of ? 5.5 mmol /l is an easier, more acceptable test for patients compared to the GCT. Using the FPG levels is also more cost effective and allows nearly 70% of women to avoid the oGTT.

Rajab, Khalil E.; Skerman, Jonathan H.; Issa, Abdulla A.

2003-01-01

101

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

PubMed

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. PMID:23657602

Collares, C V A; Evangelista, A F; Xavier, D J; Takahashi, P; Almeida, R; Macedo, C; Manoel-Caetano, F; Foss, M C; Foss-Freitas, M C; Rassi, D M; Sakamoto-Hojo, E T; Passos, G A; Donadi, E A

2013-05-09

102

Promoting Health After Gestational Diabetes: A National Diabetes Education Program Call to Action  

PubMed Central

The National Diabetes Education Program joins the American College of Obstetricians and Gynecologists (the College) to promote opportunities for obstetrician-gynecologists and other primary care providers to better meet the long-term health needs of women with prior gestational diabetes mellitus (GDM) and their children. Up to one third of GDM women may have diabetes or pre-diabetes postpartum, yet only about half of these women are tested postpartum, and about a quarter are tested 6 to 12 weeks postpartum. Women with GDM face a lifelong increased risk for subsequent diabetes, primarily type 2. Timely testing for pre-diabetes may provide an opportunity for obstetrician-gynecologists to prevent or delay the onset of type 2 diabetes through diet, physical activity, weight management, and/or pharmacological intervention. The College and American Diabetes Association recommend testing women with a history of GDM at six to 12 weeks postpartum. If the postpartum test is normal, retest every three years and at first prenatal visit in a subsequent pregnancy. If pre-diabetes is diagnosed, test annually. Since children of GDM pregnancies face an increased risk for obesity and type 2 diabetes, families need support to develop healthy eating and physical activity behaviors. Current criteria indicate that GDM occurs in 2 to 10 percent of all pregnancies. If new GDM diagnostic criteria are used, the frequency of GDM may increase to about 18 percent of pregnancies annually. The projected increase in the number of women with GDM and the potential subsequent associated risks underscore the need for proactive long-term primary care management of the mother and her offspring.

Landon, Mark; Warren-Boulton, Elizabeth; Fradkin, Judith

2011-01-01

103

Modulation of adenosine transport by insulin in human umbilical artery smooth muscle cells from normal or gestational diabetic pregnancies  

PubMed Central

Adenosine transport was measured in human cultured umbilical artery smooth muscle cells, isolated from non-diabetic or gestational diabetic pregnancies, under basal conditions and after pretreatment in vitro with insulin. Adenosine transport in non-diabetic smooth muscle cells was significantly increased by insulin (half-maximal stimulation at 0.33 ± 0.02 nm, 8 h) and characterized by a higher maximal rate (Vmax) for nitrobenzylthioinosine (NBMPR)-sensitive (es) saturable nucleoside transport (17 ± 5 vs. 52 ± 12 pmol (?g protein)?1 min?1, control vs. insulin, respectively) and maximal binding sites (Bmax) for [3H]NBMPR (0.66 ± 0.07 vs. 1.1 ± 0.1 fmol (?g protein)?1, control vs. insulin, respectively), with no significant changes in Michaelis-Menten (Km) and dissociation (Kd) constants. In contrast, in smooth muscle cells from diabetic pregnancies, where the values of Vmax for adenosine transport (59 ± 4 pmol (?g protein)?1 min?1) and Bmax for [3H]NBMPR binding (1.62 ± 0.16 fmol (?g protein)?1) were significantly elevated by comparison with non-diabetic cells, insulin treatment (1 nm, 8 h) reduced the Vmax for adenosine transport and Bmax for [3H]NBMPR binding to levels detected in non-diabetic cells. In non-diabetic cells, the stimulatory effect of insulin on adenosine transport was mimicked by dibutyryl cGMP (100 nm) and reduced by inhibitors of phosphatidylinositol 3-kinase (10 nm wortmannin), nitric oxide synthase (100 ?mNG-nitro-l-arginine methyl ester, l-NAME) or protein synthesis (1 ?m cycloheximide), whereas inhibition of adenylyl cyclase (100 ?m SQ-22536) had no effect. Wortmannin or SQ-22536, but not l-NAME or cycloheximide, attenuated the inhibitory action of insulin on the diabetes-induced stimulation of adenosine transport. Protein levels of inducible NO synthase (iNOS) were similar in non-diabetic and diabetic cells, but were increased by insulin (1 nm, 8 h) only in non-diabetic smooth muscle cells. Our results suggest that adenosine transport via the es nucleoside transporter is modulated differentially by insulin in either cell type. Insulin increased adenosine transport in non-diabetic cells via NO and cGMP, but inhibited the diabetes-elevated adenosine transport via activation of adenylyl cyclase, suggesting that the biological actions of adenosine may be altered under conditions of sustained hyperglycaemia in uncontrolled diabetes.

Aguayo, Claudio; Flores, Carlos; Parodi, Jorge; Rojas, Romina; Mann, Giovanni E; Pearson, Jeremy D; Sobrevia, Luis

2001-01-01

104

Gestational diabetes mellitus: advocating for policy change in India.  

PubMed

A multimedia awareness and advocacy campaign for mainstreaming gestational diabetes mellitus (GDM) in the public health domain is described. The multimedia campaign has created awareness about the relevance of GDM to women's health and the health of future generations through direct contact, reaching out to over half a million people in 7 districts of 4 states in northern India. Using mass media, over 3.7 million people have received information on GDM. Through multistakeholder forums, more than 1000 key stakeholders have been encouraged to mainstream GDM into the existing health delivery system. The Indian Ministry of Health has introduced free screening for GDM among the 5 services offered to pregnant women below the poverty line in the National Rural Health Mission (NRHM) program. In addition, several state governments, such as in Bihar, Delhi, Jharkhand, and Punjab, have pledged similar initiatives addressing GDM; the Government of Tamil Nadu is already implementing such a policy. Policy development is a complex process that requires action on many fronts. By showcasing evidence, raising awareness, creating public opinion through dialogue and discussion, media can help build a positive environment and momentum for effective policy creation as well as service utilization. PMID:22099441

Madhab, Anand; Prasad, Vishwa Mohan; Kapur, Anil

2011-11-01

105

Gestational diabetes and the risk of breast cancer among women in the Jerusalem Perinatal Study  

Microsoft Academic Search

Gestational diabetes is becoming increasingly common; it is important to determine how it relates to future risk of disease.\\u000a We investigated the relation of gestational diabetes to breast cancer in 37,926 women who had one or more live births in 1964–1976\\u000a for whom information had been collected on complications of pregnancy. In this cohort there were 1,626 cases of breast

M. C. Perrin; M. B. Terry; K. Kleinhaus; L. Deutsch; R. Yanetz; E. Tiram; R. Calderon-Margalit; Y. Friedlander; O. Paltiel; S. Harlap

2008-01-01

106

Genotypic and phenotypic differences between Arabian and Scandinavian women with gestational diabetes mellitus  

Microsoft Academic Search

Aims\\/hypothesis  Gestational diabetes mellitus is a heterogeneous disorder characterised by impaired insulin secretion and action. Our aim was to study whether autoimmunity, variations in genes affecting insulin secretion and action, or both, contribute to the development of gestational diabetes and whether the pathogenesis of the disease differs between women with a Scandinavian or Arabian background.Methods  We studied a total of 500 unrelated

N. Shaat; M. Ekelund; Å. Lernmark; S. Ivarsson; A. Nilsson; R. Perfekt; K. Berntorp; L. Groop

2004-01-01

107

New Guidelines for Diagnosis of Gestational Diabetes: Pathology-Based Impact Assessment  

PubMed Central

Background: A recent study indicated an average of 19.5% abnormal oral glucose tolerance in antenatal clients per year. Aim: The purpose of this study was to determine the impact on gestational diabetes cases due to new guidelines for diagnosis and classification of hyperglycaemia in pregnancy. Materials and Methods: This study reviewed the archived clinical pathology data on oral glucose tolerance tests performed between January 1999 and December 2008 on antenatal clients (N = 615). The cases were reviewed to determine changes if any in percentage of gestational diabetes due to new guidelines. Results: Over the 10 years period, a yearly average of additional 10.8% antenatal cases suggestive of gestational diabetes was observed due to the new recommended thresholds. Further, the average yearly incidence would have increased from 8.8 cases to 16.2 cases, which translates to almost 46% increase in the prospective numbers of gestational diabetes. Conclusions: This report presents the extent of how the new recommended guidelines for diagnosis and classification of hyperglycaemia in pregnancy could increase the prevalence of gestational diabetes. It also provides pathology-based evidence for the epidemiology of gestational diabetes mellitus and allows for planning the costs that would be attendant to the full implementation of the new guidelines.

Nwose, Ezekiel Uba; Richards, Ross Stuart; Bwititi, Phillip Taderera; Butkowski, Eugene George

2013-01-01

108

Changes in prepregnancy body mass index between pregnancies and risk of gestational and type 2 diabetes  

Microsoft Academic Search

Introduction  We investigated whether changes in interpregnancy body mass index (BMI) influence the risk of gestational and type 2 diabetes\\u000a among a cohort of women with two consecutive live, singleton births of 20–44 weeks gestation (n = 232,272).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Logistic regression models were used to examine the risk for development of gestational or type 2 diabetes during the second\\u000a pregnancy. Mothers with normal weight for

Valerie E. Whiteman; Muktar H. Aliyu; Euna M. August; Cheri McIntosh; Jingyi Duan; Amina P. Alio; Hamisu M. Salihu

2011-01-01

109

Percentage of Gestational Diabetes Mellitus Attributable to Overweight and Obesity  

PubMed Central

Objectives. We calculated the percentage of gestational diabetes mellitus (GDM) attributable to overweight and obesity. Methods. We analyzed 2004 through 2006 data from 7 states using the Pregnancy Risk Assessment Monitoring System linked to revised 2003 birth certificate information. We used logistic regression to estimate the magnitude of the association between prepregnancy body mass index (BMI) and GDM and calculated the percentage of GDM attributable to overweight and obesity. Results. GDM prevalence rates by BMI category were as follows: underweight (13–18.4 kg/m2), 0.7%; normal weight (18.5–24.9 kg/m2), 2.3%; overweight (25–29.9 kg/m2), 4.8%; obese (30–34.9 kg/m2), 5.5%; and extremely obese (35–64.9 kg/m2), 11.5%. Percentages of GDM attributable to overweight, obesity, and extreme obesity were 15.4% (95% confidence interval [CI] = 8.6, 22.2), 9.7% (95% CI = 5.2, 14.3), and 21.1% (CI = 15.2, 26.9), respectively. The overall population-attributable fraction was 46.2% (95% CI = 36.1, 56.3). Conclusions. If all overweight and obese women (BMI of 25 kg/m2 or above) had a GDM risk equal to that of normal-weight women, nearly half of GDM cases could be prevented. Public health efforts to reduce prepregnancy BMI by promoting physical activity and healthy eating among women of reproductive age should be intensified.

England, Lucinda; Wilson, Hoyt G.; Bish, Connie; Satten, Glen A.; Dietz, Patricia

2010-01-01

110

Neonatal hyperthyrotropinemia in gestational diabetes mellitus and perinatal complications.  

PubMed

The aim of this study is to explore the relationship between high cord blood thyroid-stimulating hormone (TSH) level and in-utero stress to the fetus in gestational diabetes mellitus (GDM). Cord blood TSH results were analyzed in 1,578 euthyroid infants from singleton pregnancies with GDM: 103 with elevated TSH (>16 mIU/l) and 1,475 with normal TSH. Maternal characteristics, pregnancy outcome and perinatal complications were compared between the two groups. Multiple logistic regression was used to study the association between high cord blood TSH level and various perinatal complications which reflect in-utero stress in GDM after adjusting for the confounding effects of parity, instrumental delivery, cesarean section and baby gender. High cord blood TSH level was found to be associated with the 1-min Apgar score <7 (OR 3.31, 95% CI 1.78-6.16), birth trauma (OR 3.44, 95% CI 1.11-10.69), neonatal jaundice requiring treatment (OR 2.08, 95% CI 1.30-3.32), neonatal sepsis (OR 2.34, 95% CI 1.24-4.42), respiratory complications (OR 3.45, 95% CI 1.37-8.70), neurological complications (OR 8.01, 95% CI 1.91-33.60) and overall perinatal morbidity (OR 2.41, 95% CI 1.58-3.67). Cord blood TSH level seems to be a better and independent indicator of the in-utero stress to the fetus in GDM when compared to the commonly used sugar profile result and HbA1c level. PMID:15475663

Leung, Wing Cheong; Chan, Karen K L; Lao, Terence T

2004-10-06

111

Diabetes, gestational diabetes and the risk of cancer in women: epidemiologic evidence and possible biologic mechanisms.  

PubMed

At present, more than 10% of adult American women are diagnosed with diabetes mellitus (DM). As the prevalence of the disease increases, there is greater interest in the relationship between DM and other major health issues, such as cancer - one of the leading causes of death in the western world. This paper reviews the literature on the relationship between Type 2 DM and different types of cancer among women. We discuss the possible biological mechanisms that may link diabetes and cancer, important confounders, shared risk factors and a short review of the epidemiologic literature on the association between Type 2 DM and cancer of specific organs (pancreas, liver, colorectal, bladder, endometrial, non-Hodgkin's lymphoma and breast). We also examine the association between gestational diabetes, a closely related risk factor for DM in women, and subsequent risk of cancer. Cancer survival of diabetic women is also briefly discussed. The paper concludes with an agenda for future research targeting the relationship between diabetes and cancer. PMID:21410348

Chodick, Gabriel; Zucker, Inbar

2011-03-01

112

Gestational Diabetes and Postpartum Physical Activity: Evidence of Lifestyle Change 1 Year After Delivery  

Microsoft Academic Search

Although women with gestational diabetes mellitus (GDM) are advised to incorporate physical activity into their lifestyle in order to reduce their risk of developing type 2 diabetes (T2DM), it is recognized that new mothers face barriers to postpartum exercise. Thus, we sought to determine whether, following the diagnosis of GDM, women indeed alter their postpartum physical activity patterns, as compared

Ravi Retnakaran; Ying Qi; Mathew Sermer; Philip W. Connelly; Bernard Zinman; Anthony J. Hanley

2010-01-01

113

The assessment of plasma ghrelin levels in women with gestational diabetes  

Microsoft Academic Search

Background. Ghrelin is a 28-amino acid peptide stimulat- ing growth hormone secretion and regulating feeding be- havior. Reduced plasma ghrelin levels were found in pa- tients with obesity and type 2 diabetes. In this study we compared plasma ghrelin concentrations in pregnant women with gestational diabetes (GDM) and normal glucose toler- ance (NGT). Material and methods. The group studied consisted

Beata Telejko; Anna Zonenberg; Mariusz Kuzmicki; Anna Modzelewska; Barbara Zarzycka; Agnieszka Nikolajuk; Karolina Niedziolko-Bagniuk; Agnieszka Ponurkiewicz; Jacek Szamatowicz; Maria Gorska

114

A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus  

Microsoft Academic Search

Despite the maternal and infant morbidity associated with gestational diabetes mellitus (GDM), few modifiable risk factors have been identified. We explored the relation between recreational physical activity performed during the year before and during the first 20 weeks of pregnancy and the risk of GDM. 155 GDM cases and 386 normotensive, non-diabetic pregnant controls provided information about the type, intensity,

Jennifer C. Dempsey; Carole L. Butler; Tanya K. Sorensen; I-Min Lee; Mary Lou Thompson; Raymond S. Miller; Ihunnaya O. Frederick; Michelle A. Williams

2004-01-01

115

Beta-cell function and visceral fat in lactating women with a history of gestational diabetes  

Microsoft Academic Search

Lactation has been recommended as beneficial for the maternal metabolic abnormalities associated with glucose intolerance and diabetes risk, although associations between breastfeeding (BF), glucose tolerance, and adipose tissue distribution are unknown. Therefore, a population of women with recent gestational diabetes (GDM) was evaluated with comparison of results for lactating versus nonlactating women. A total of 26 women participated (14 BF

Ruth M. McManus; Ian Cunningham; Annette Watson; Lynda Harker; Diane T. Finegood

2001-01-01

116

Advice that includes food sources of unsaturated fat supports future risk management of gestational diabetes mellitus  

Microsoft Academic Search

Women with gestational diabetes mellitus (GDM) have a greater risk of developing type 2 diabetes mellitus (DM) and heart disease than pregnant women without GDM. Advice given during the GDM pregnancy provides an opportunity to develop protective dietary patterns for the long-term management of this risk. Dietary guidelines for the prevention and management of type 2 DM support the inclusion

Lynda J. Gillen; Linda C. Tapsell

2004-01-01

117

Glucose tolerance and insulin secretion in children of mothers with pregestational IDDM or gestational diabetes  

Microsoft Academic Search

Summary   The offspring of mothers with diabetes mellitus during pregnancy are presumed to develop altered glucose homeostasis. We\\u000a analysed metabolic parameters at birth and glucose tolerance and insulin secretion during oral glucose tolerance tests at\\u000a 1–9 years of age in 129 children born to mothers with pregestational insulin-dependent diabetes (IDDM) and 69 infants of gestational\\u000a diabetic mothers. Newborns of IDDM

A. Plagemann; T. Harder; R. Kohlhoff; W. Rohde; G. Dörner

1997-01-01

118

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in the US. As a consequence, a growing number of women are now at increased risk for T2DM. Opportunities to diagnose and prevent T2DM in women with a history of GDM include early diagnosis by postpartum screening and implementation of diabetes prevention measures. In this Review, we discuss current guidelines for postpartum screening, how they might be implemented, and who should take responsibility for screening individuals at risk of T2DM. In addition, we describe measures to prevent the onset of T2DM in women with a history of GDM, focusing on lifestyle modifications, such as diet and breast-feeding. PMID:18779843

Bentley-Lewis, Rhonda; Levkoff, Sue; Stuebe, Alison; Seely, Ellen W

2008-09-09

119

Insulin and Leptin Levels in Appropriate-for-Gestational-Age Infants of Diabetic Mother  

PubMed Central

Objective Intensified management of gestational diabetes mellitus can normalize birth weight. However, it is still unknown whether intrauterine exposure to maternal diabetes is a risk factor for changing hormone levels involved in the development of insulin resistance in these infants. We compared insulin and leptin levels in appropriate for gestational age (AGA) infants of diabetic and non diabetic mothers. Methods We performed a cross-sectional study in the department of Neonatology of the Hospital of Gynecology-Pediatrics, in Leon, Mexico. We evaluated 182 full term AGA newborns (86 infants of diabetic and 96 of non-diabetic mothers). A venous blood sample was taken from cord blood immediately after the separation of the placenta and glucose, insulin and leptin levels were measured. In all diabetic mothers HbA1c was also evaluated immediately post-partum. Findings Leptin, insulin and insulin resistance index were significantly higher in infants of diabetic mothers. Leptin levels were positive correlated with insulin, parents‘ body mass index and age in the entire group. In infants of diabetic mothers only insulin levels showed a significantly correlation, whereas in those of non-diabetic mothers only mothers‘ age was significantly correlated with leptin levels. Conclusion AGA infants of diabetic mothers showed higher leptin, insulin levels and insulin resistance index than those of non-diabetic mothers.

Vela-Huerta, Ma. Martha; Amador-Licona, Norma; Anaya-Aguirre, Susana; Guizar-Mendoza, Juan Manuel; Velazquez-Bustamante, Ana; Murillo-Ortiz, Blanca

2012-01-01

120

Can first-trimester screening program detect women at high risk for gestational diabetes mellitus?  

PubMed

This study was designed to compare first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency in pregnancies complicated by gestational diabetes mellitus and those of a control group. The study included 60 gestational diabetic and 60 control women who attended the first-trimester combined screening program for Down syndrome between 11 and 14 gestational weeks with complete follow-up data and delivered in our institution. Maternal serum free ?-human chorionic gonadotropin, pregnancy-associated plasma protein-A and fetal nuchal translucency were investigated. The combined risks, double test risks and age risks were calculated by PRISCA software version 4.0. Comparison of the results between the two groups yielded no significant differences in serum levels of free ?-human chorionic gonadotropin and fetal nuchal translucency. However, women who developed gestational diabetes mellitus had significantly lower pregnancy-associated plasma protein-A. And also, the combined risks and double test risks calculated by PRISCA software were statistically higher in gestational diabetic women than normal pregnant women. These results suggest that differences can be seen between diabetic and healthy pregnant women in first-trimester maternal serum biochemical markers of aneuploidy. PMID:22954283

Kulaksizoglu, Sevsen; Kulaksizoglu, Mustafa; Kebapcilar, Ayse Gul; Torun, Ayse Nur; Ozcimen, Emel; Turkoglu, Suna

2012-09-07

121

Interactions between pregnancy, obstructive sleep apnea, and gestational diabetes mellitus.  

PubMed

Context: Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known. Objective: The objective of the study was to assess the relationship between pregnancy, OSA, and GDM. Design, Setting, and Participants: We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester. Main Outcome Measures: Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured. Results: Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15-37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels. Conclusion: Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA. PMID:23966237

Reutrakul, Sirimon; Zaidi, Nausheen; Wroblewski, Kristen; Kay, Helen H; Ismail, Mahmoud; Ehrmann, David A; Van Cauter, Eve

2013-08-21

122

Evidence-based strategies for managing gestational diabetes in women with obesity.  

PubMed

Pregnancies complicated by both obesity and gestational diabetes mellitus (GDM) increase the risk of maternal and fetal complications, including but not limited to gestational hypertension, cesarean surgical birth, fetal macrosomia and postpartum hemorrhage. Because of the increased maternal and fetal risks associated with maternal obesity and GDM, the development of evidence-based strategies for screening for and management of GDM and for timing of birth will provide a comprehensive approach needed to optimize outcomes for both women and newborns. PMID:24138661

Elkins, Donnay; Taylor, Julie Smith

2013-10-01

123

The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes  

Microsoft Academic Search

Objective:To determine the effects of tobacco use on perinatal outcomes among patients with gestational diabetes (GDM).Study Design:This was a retrospective cohort study of singleton pregnancies with GDM and live births from 2003 to 2006. The primary outcome, large for gestational age (LGA) infants, was compared between smoking and nonsmoking groups. Secondary outcomes included cesarean deliveries, shoulder dystocia, birth trauma, peripartum

K R Contreras; M A Kominiarek; T W Zollinger

2010-01-01

124

Universal versus selective screening for the detection, control and prognosis of gestational diabetes mellitus in Argentina  

Microsoft Academic Search

In all, 1,702 unselected pregnant women from the city of La Plata were tested for gestational diabetes mellitus (GDM) and\\u000a evaluated to determine GDM prevalence and risk factors. In women with GDM, we evaluated compliance with guidelines for GDM\\u000a management, and perinatal complications attributable to GDM. GDM prevalence was 5.8%, and its risk factors were pre-gestational\\u000a obesity, previous hyperglycaemia, age > 30 years,

Antonio Desmond McCarthy; Renata Curciarello; Nicolás Castiglione; Marina Fernández Tayeldín; Diego Costa; Verónica Arnol; Anabela Prospitti; Analía Aliano; Daniela Archuby; Augusto Graieb; María J. Torres; Susana B. Etcheverry; María C. Apezteguía

2010-01-01

125

Life-course weight characteristics and the risk of gestational diabetes  

Microsoft Academic Search

Aims\\/hypothesis  We prospectively determined the risk of gestational diabetes mellitus in association with life-course weight characteristics\\u000a and adult abdominal adiposity.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We investigated the joint and independent impact of birthweight, childhood size by somatotypes, adolescent and adult BMI,\\u000a and abdominal adiposity on gestational diabetes mellitus risk among the 21,647 women in the Nurses’ Health Study II who reported\\u000a a singleton pregnancy between

E. H. Yeung; F. B. Hu; C. G. Solomon; L. Chen; G. M. Louis; E. Schisterman; W. C. Willett; C. Zhang

2010-01-01

126

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

PubMed

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. PMID:16019569

Smith-Morris, Carolyn M

127

Prospective Study of Gestational Diabetes Mellitus Risk in Relation to Maternal Recreational Physical Activity before and during Pregnancy  

Microsoft Academic Search

Physical activity has been associated with a reduced risk of gestational diabetes mellitus, but inferences have been hampered by recall and selection bias. The authors examined the relation between recreational physical activity before and during pregnancy and risk of gestational diabetes mellitus in a prospective cohort study. In 1996-2000, 909 normotensive, nondiabetic women in Seattle and Tacoma, Washington, were questioned

Jennifer C. Dempsey; Tanya K. Sorensen; Michelle A. Williams; I-Min Lee; Raymond S. Miller; Edward E. Dashow; David A. Luthy

128

Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus  

Microsoft Academic Search

Objective: This study prospectively evaluated the longitudinal changes in insulin sensitivity, insulin response, and endogenous (primarily hepatic) glucose production and suppression during insulin infusion in women with normal glucose tolerance (control) and gestational diabetes mellitus before and during a planned pregnancy. Study Design: Eight control subjects and 7 subjects in whom gestational diabetes mellitus developed were evaluated with an oral

Patrick M. Catalano; Larraine Huston; Saeid B. Amini; Satish C. Kalhan

1999-01-01

129

Modelling effective diagnosis of risk complications in gestational diabetes mellitus: an e-diabetic expert system for pregnant women  

NASA Astrophysics Data System (ADS)

Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. This paper deals with study and development of algorithm to develop an initial stage expert system to provide diagnosis to the pregnant women who are suffering from Gestational Diabetes Mellitus (GDM) by means of Oral Glucose Tolerance Test (OGTT).

Sreedevi, E.; Vijaya Lakshmi, K.; Chaitanya Krishna, E.; Padmavathamma, M.

2012-04-01

130

Moderate exercise improves glucose metabolism in uncontrolled elderly patients with non-insulin-dependent diabetes mellitus.  

PubMed

Exercise should be an integral part of the treatment in non-insulin-dependent (NIDDM) diabetic patients, yet most of these patients' performance is low, mainly because of their obesity and concomitant macrovascular disease. We studied the influence of a moderate exercise training on parameters of glucose control in NIDDM patients. Forty patients aged 56.6 +/- 6.6 years were assigned randomly according to age and sex into exercise and control groups. The exercise group trained for 45 min 3 times weekly for 12 weeks, while the control group did not change their lifestyle. At the end of the study the exercise group had a significant reduction in plasma levels of triglycerides, fructosamine and glycohemoglobin. The improvement in metabolic control persisted significantly in patients who continued to exercise at varying levels at home during 1 year of follow-up. PMID:7960690

Raz, I; Hauser, E; Bursztyn, M

1994-10-01

131

Association of Six Single Nucleotide Polymorphisms with Gestational Diabetes Mellitus in a Chinese Population  

Microsoft Academic Search

BackgroundTo investigate whether the candidate genes that confer susceptibility to type 2 diabetes mellitus are also correlated with gestational diabetes mellitus (GDM) in pregnant Chinese women.Methodology\\/Principal FindingsIn this study, 1764 unrelated pregnant women were recruited, of which 725 women had GDM and 1039 served as controls. Six single nucleotide polymorphisms (rs7754840 in CDKAL1, rs391300 in SRR, rs2383208 in CDKN2A\\/2B, rs4402960

Ying Wang; Min Nie; Wei Li; Fan Ping; Yingying Hu; Liangkun Ma; Jinsong Gao; Juntao Liu

2011-01-01

132

Diet and weight gain characteristics of pregnant women with gestational diabetes  

Microsoft Academic Search

Background\\/Objectives:To determine if women with gestational diabetes (GD) modify their diet and nutrient intake in late pregnancy and gain more weight during pregnancy compared with women without GD.Subjects\\/Methods:Food and nutrient intake of 3613 pregnant women was studied using food frequency questionnaires from the Type I Diabetes Prediction and Prevention Nutrition Study.Results:GD was reported in 4.8% of the participating women (n=174).

M Salmenhaara; L Uusitalo; U Uusitalo; C Kronberg-Kippilä; H Sinkko; S Ahonen; R Veijola; M Knip; M Kaila; S M Virtanen

2010-01-01

133

Promoting Breastfeeding Among Obese Women and Women with Gestational Diabetes Mellitus  

Microsoft Academic Search

Breastfeeding has many health benefits for women and their babies, but particularly if the woman is obese and\\/or had a pregnancy\\u000a affected with gestational diabetes mellitus (GDM). Women who have had GDM are at high risk for developing metabolic syndrome\\u000a or type 2 diabetes, and their offspring are at greater risk for these metabolic disorders both in childhood and later

Kimberly K. Trout; Tali Averbuch; Meghan Barowski

2011-01-01

134

Maternal Plasma 25-Hydroxyvitamin D Concentrations and the Risk for Gestational Diabetes Mellitus  

Microsoft Academic Search

BackgroundEvidence is accumulating for a role of vitamin D in maintaining normal glucose homeostasis. However, studies that prospectively examined circulating concentrations of 25-hydroxyvitamin D (25-[OH] D) in relation to diabetes risk are limited. Our objective is to determine the association between maternal plasma 25-[OH] D concentrations in early pregnancy and the risk for gestational diabetes mellitus (GDM).MethodsA nested case-control study

Cuilin Zhang; Chunfang Qiu; Frank B. Hu; Robert M. David; Rob M. van Dam; Alexander Bralley; Michelle A. Williams; Per Westermark

2008-01-01

135

Early Second-Trimester Serum MiRNA Profiling Predicts Gestational Diabetes Mellitus  

Microsoft Academic Search

BackgroundGestational diabetes mellitus (GDM) is one type of diabetes that presents during pregnancy and significantly increases the risk of a number of adverse consequences for the fetus and mother. The microRNAs (miRNA) have recently been demonstrated to abundantly and stably exist in serum and to be potentially disease-specific. However, no reported study investigates the associations between serum miRNA and GDM.Methodology\\/Principal

Chun Zhao; Jing Dong; Tao Jiang; Zhonghua Shi; Bin Yu; Yunlong Zhu; Daozhen Chen; Junrong Xu; Ran Huo; Juncheng Dai; Yankai Xia; Shiyang Pan; Zhibin Hu; Jiahao Sha

2011-01-01

136

Abdominal circumference vs. estimated weight to predict large for gestational age birth weight in diabetic pregnancy  

Microsoft Academic Search

Early third trimester fetal abdominal circumference and sonographic fetal weight estimates were compared to predict large for gestational age birth weight in diabetic pregnancy. Both parameters have similar sensitivity, specificity, and predictive values. However, the optimal percentile cutoff values differ. Choice of birth weight standard significantly influences test characteristics. Negative prediction of large birth weight is more accurate than positive

William L Holcomb; Dorothea J Mostello; Diana L Gray

2000-01-01

137

Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus?  

Microsoft Academic Search

Objective: The purpose of this study was to investigate the insulin response to a 3-hour oral glucose tolerance test and to compare the insulin levels in the gestational diabetes mellitus and single abnormal test value groups with a nondiabetic control group. Study Design: One hundred ten Turkish women with uncomplicated pregnancy participated in this prospective controlled study between 24 to

Tolga Ergin; Arda Lembet; Hakan Duran; Esra Kuscu; Tayfun Bagis; Esra Saygili; Sertac Batioglu

2002-01-01

138

Food Perceptions and Concerns of Aboriginal Women Coping with Gestational Diabetes in Winnipeg, Manitoba  

ERIC Educational Resources Information Center

|Objective: To describe how Aboriginal women in an urban setting perceive dietary treatment recommendations associated with gestational diabetes mellitus (GDM). Design: Semi-structured explanatory model interviews explored Aboriginal women's illness experiences with GDM. Setting and Participants: Twenty-nine self-declared Aboriginal women who had…

Neufeld, Hannah Tait

2011-01-01

139

Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus  

Microsoft Academic Search

OBJECTIVE — We aimed to examine whether pregravid dietary fiber consumptions from cereal, fruit, and vegetable sources and dietary glycemic load were related to gestational diabetes mellitus (GDM) risk. RESEARCH DESIGN AND METHODS — This study was a prospective cohort study among 13,110 eligible women in the Nurses' Health Study II. GDM was self-reported and validated by medical record review

CUILIN ZHANG; SIMIN LIU; CAREN G. SOLOMON; FRANK B. HU

140

Cost of Gestational Diabetes Mellitus in the United States in 2007  

Microsoft Academic Search

The objective of this study was to estimate the national medical costs associated with gestational diabetes mellitus (GDM) in 2007. We analyzed the National Hospital Discharge Survey to estimate the national preva- lence of GDM. Using Poisson regression analysis with medical claims for about 27,000 newborns and their mothers, we estimated rate ratios that reflect the increase in use of

Yaozhu Chen; William W. Quick; Wenya Yang; Yiduo Zhang; Alan Baldwin; Jane Moran; Victoria Moore; Navita Sahai; Timothy M. Dall

2009-01-01

141

Gestational Diabetes and Preeclampsia in Association with Air Pollution at Levels below Current Air Quality Guidelines  

PubMed Central

Background: Several studies have estimated associations between air pollution and birth outcomes, but few have evaluated potential effects on pregnancy complications. Objective: We investigated whether low-level exposure to air pollution is associated with gestational diabetes and preeclampsia. Methods: High-quality registry information on 81,110 singleton pregnancy outcomes in southern Sweden during 1999–2005 was linked to individual-level exposure estimates with high spatial resolution. Modeled exposure to nitrogen oxides (NOx), expressed as mean concentrations per trimester, and proximity to roads of different traffic densities were used as proxy indicators of exposure to combustion-related air pollution. The data were analyzed by logistic regression, with and without adjusting for potential confounders. Results: The prevalence of gestational diabetes increased with each NOx quartile, with an adjusted odds ratio (OR) of 1.69 (95% CI: 1.41, 2.03) for the highest (> 22.7 µg/m3) compared with the lowest quartile (2.5–8.9 µg/m3) of exposure during the second trimester. The adjusted OR for acquiring preeclampsia after exposure during the third trimester was 1.51 (1.32, 1.73) in the highest quartile of NOx compared with the lowest. Both outcomes were associated with high traffic density, but ORs were significant for gestational diabetes only. Conclusion: NOx exposure during pregnancy was associated with gestational diabetes and preeclampsia in an area with air pollution levels below current air quality guidelines.

Jakobsson, Kristina; Tinnerberg, Hakan; Rignell-Hydbom, Anna; Rylander, Lars

2013-01-01

142

Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes  

Microsoft Academic Search

OBJECTIVE: Our purpose was to assess maternal-fetal outcomes in patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes.STUDY DESIGN: We conducted a prospective analytic cohort study in which nondiabetic women aged ?24 years, receiving prenatal care in three Toronto teaching hospitals, were eligible for enrollment. A glucose challenge test and an oral glucose

Mathew Sermer; C. David Naylor; Douglas J. Gare; Anne B. Kenshole; J. W. K. Ritchie; Dan Farine; Howard R. Cohen; Karen McArthur; Stephen Holzapfel; Anne Biringer; Erluo Chen

1995-01-01

143

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study  

Microsoft Academic Search

Objective To evaluate whether measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes mellitus than the 1 hour 50 g glucose challenge test. Design Prospective population based study. Setting Outpatient clinic in a university hospital. Participants 520 pregnant women (328 (63%) white, 99 (19%) Asian, 31 (6%) African, 62 (12%) others) with mean age 28.4 (SD

Daniele Perucchini; Ursin Fischer; Giatgen A Spinas; Renate Huch; Albert Huch; Roger Lehmann

1999-01-01

144

The effect of gender and gestational diabetes mellitus on cord leptin concentration  

Microsoft Academic Search

Objective: The purpose of this study was to determine the relationship of neonatal sex and gestational diabetes mellitus on cord leptin concentration and to determine whether cord leptin has a stronger correlation with fat mass compared with birth weight or lean body mass. We hypothesized that there are no significant differences in fetal leptin concentration between male and female or

Ndubueze C. Okereke; Jennifer Uvena-Celebrezze; Larraine Hutson-Presley; Saeid B. Amini; Patrick M. Catalano

2002-01-01

145

Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus  

PubMed Central

OBJECTIVE: To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS: Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS: The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS: The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies.

Barbosa, Angelica Mercia Pascon; Dias, Adriano; Marini, Gabriela; Calderon, Iracema Mattos Paranhos; Witkin, Steven; Rudge, Marilza Vieira Cunha

2011-01-01

146

Agreement between self-report and birth certificate for gestational diabetes mellitus: New York State PRAMS.  

PubMed

This study examined agreement (concordance or convergent validity) between self-report and birth certificate for gestational diabetes. Study population was 2,854 women who had live births 2-6 months earlier and responded to a questionnaire from the New York State Pregnancy Risk Assessment Monitoring System (PRAMS) survey, 2004-2006. Agreement between self-report and birth certificate was assessed for the study population overall, and for subgroups defined by race, age, education, marital status, number of previous live births, time of first prenatal care, and birth weight of the newborn. A total of 258 women self-reported gestational diabetes, while birth certificates indicated that 138 women had gestational diabetes. For the study population overall, percent agreement was 93.8% and Kappa was 0.53. Due to the moderate bias index (68.2% overall, ranged from 33.3 to 100% in subgroups) and the high skewed prevalence index (91.8% overall, ranged from 70.7 to 97.5% in subgroups), we determined Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) was a better measure of agreement. PABAK was 0.88 overall, indicating very good agreement. PABAK was uniformly high in all subgroups. The highest PABAK was found among women aged 25 years and younger (0.93), and the lowest PABAK was among Asian women (0.79). Although the absence of a gold standard for gestational diabetes hinders assessment of criterion validity, high PABAK measures suggest that self-reporting by PRAMS respondents is feasible for identifying cases of gestational diabetes for surveillance and population-based epidemiologic research. PMID:19838778

Hosler, Akiko S; Nayak, Seema G; Radigan, Anne M

2010-09-01

147

Glycemic Characteristics and Neonatal Outcomes of Women Treated for Mild Gestational Diabetes  

PubMed Central

OBJECTIVE To estimate the association between fasting and 2-hour postprandial blood glucose levels and neonatal outcomes in women treated for mild gestational diabetes. METHODS In this secondary analysis of a multicenter randomized treatment trial of mild gestational diabetes, the median fasting and 2-hour postprandial glucose levels were analyzed in 2-week intervals and change over time (slope) was calculated for women with gestational diabetes (abnormal oral glucose tolerance test) and a fasting glucose less than 95 mg/dL who received nutritional management with self blood glucose monitoring and insulin as needed. Regression analyses were performed to estimate the relationship between median fasting and postprandial glucose and neonatal fat mass, cord blood C-peptide, birth weight, large-for-gestational-age neonates, macrosomia (greater than 4,000 g), and neonatal hypoglycemia. RESULTS Among 460 women with gestational diabetes, median fasting (P<.001), postprandial breakfast (P<.001), and postprandial lunch (P<.001) glucose values declined over the treatment period, whereas postprandial dinner values remained stable (P=.83). Higher median fasting glucose during the first 2 weeks of treatment was significantly associated with increased odds ratios for neonatal fat mass (1.35; 95% CI 1.09–1.66; P=.006) and elevated C-peptide (1.29; CI 1.09–1.52; P=.003). Higher median fasting glucose during the last 2 weeks before delivery was associated with higher rates of large-for-gestational-age neonates (1.27; CI 1.05–1.53; P=.01), macrosomia (1.32; CI 1.04–1.65; P = .02), and elevated C-peptide (1.19; CI 1.03–1.38; P=.02). CONCLUSION In women treated for mild gestational diabetes, higher fasting glucose during initiation of diet therapy was associated with increased neonatal fat mass and elevated C-peptide and during the last 2 weeks before delivery with macrosomia, large-for-gestational age, and elevated C-peptide. LEVEL OF EVIDENCE II

Durnwald, Celeste P.; Mele, Lisa; Spong, Catherine Y.; Ramin, Susan M.; Varner, Michael W.; Rouse, Dwight J.; Sciscione, Anthony; Catalano, Patrick; Saade, George; Sorokin, Yoram; Tolosa, Jorge E.; Casey, Brian; Anderson, Garland D.

2012-01-01

148

The postpartum management of women with gestational diabetes using a continuum model for health care.  

PubMed

Women with gestational diabetes mellitus require a continuum of care before, during, and after pregnancy for optimal management of hyperglycemia. Postpartum education and lifestyle modification should begin during pregnancy, and should continue during the postpartum period. Women should receive education on the long-term risk of type 2 diabetes mellitus, and should be encouraged to breastfeed, engage in regular physical activity, and select a highly effective contraceptive method in preparation for subsequent pregnancy. Postpartum women with gestational diabetes mellitus should be empowered to take ownership of their own health, including knowledge of health indicators such as weight, waist circumference hemoglobin A1C levels, and fasting and postprandial blood glucose levels. PMID:24036480

Castorino, Kristin; Jovanovi?, Lois

2013-12-01

149

Accelerated metabolic susceptibility to type 2 diabetes in older women with a history of gestational diabetes  

PubMed Central

The purpose of this study is to compare central obesity, insulin sensitivity, and cardiovascular disease risk factors between premenopausal and postmenopausal women with a history of gestational diabetes mellitus (GDM), controls, and women with type 2 diabetes (T2DM). Subjects were 73 overweight/obese and sedentary women who had a history of GDM (n=31) and were either premenopausal (n=11, 44±1 years, X±s.e.m.), postmenopausal (n=20, 58±1 years), or without a history of GDM as healthy postmenopausal controls (n=27, 57±1 years) or postmenopausal with T2DM (n=16, 59±1 years). The premenopausal GDM women had higher maximal oxygen uptake and lower visceral fat than the other three groups (P<0.05). BMI, %body fat, subcutaneous abdominal fat, and intramuscular fat did not differ significantly among the four groups. Glucose utilization (M, 3?h 40?mU/m2 per min hyperinsulinemic–euglycemic clamps) was 27% higher (P=0.05) in pre- than postmenopausal GDM and was not different between premenopausal GDM and postmenopausal controls. M was 28% lower (P=0.06) in postmenopausal GDM than controls and was not significantly different between postmenopausal GDM and T2DM groups. Thus, despite being younger and more physically fit, premenopausal women with prior GDM display similar central obesity, glucose, and metabolic profiles as postmenopausal controls. Postmenopausal women with prior GDM are more insulin resistant than controls of similar age, adiposity, and fitness levels and display comparable glucose utilization rates as similar as women with T2DM suggesting that a prior history of GDM may be an early manifestation of increased risk of later T2DM.

Ryan, Alice S; McLenithan, John C; Zietowski, Gretchen M

2013-01-01

150

Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis  

PubMed Central

Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature up to October 2009. Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or “intensified” compared with “less intensified” specific treatment. Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70). Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).

2010-01-01

151

A Case Study of a Pregnant Patient with a Congenital Heart Block Accompanied by Left Isomerism and Uncontrolled Type 2 Diabetes Who Was Treated Successfully with Ritodrine  

Microsoft Academic Search

We present a case study of a patient with a congenital heart block associated with a left isomerism that was diagnosed during the 26th week of gestation. The mother had type 2 diabetes mellitus that was difficult to control during the early stages of the pregnancy. A fetal echocardiogram revealed an atrioventricular dissociation, with an atrial rate of 120 bpm

Takehiro Serikawa; Kaya Ichikawa; Akira Kikuchi; Koichi Takakuwa; Kenichi Tanaka

2010-01-01

152

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus  

Microsoft Academic Search

Postprandial glucose has been reported to be the best predictor of neonatal macrosomia. Therefore, self-blood glucose monitoring\\u000a (SBGM) protocols for diabetic pregnant women stress the importance of measuring blood glucose after meals. However, there\\u000a is controversy in the literature. Traditionally, glucose monitoring has been prescribed at 2 hours after eating to coincide\\u000a with the times a patient is at increased

Lois Jovanovic

2001-01-01

153

Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes  

Microsoft Academic Search

Objectives: We sought to determine the types of congenital anomalies affecting infants of women with gestational diabetes mellitus or type 2 diabetes and to examine the relationship between those malformation types and measures of initial glycemia of women at entry into prenatal care with type 2 diabetes or at time of diagnosis in women with gestational diabetes mellitus. Study Design:

Ute M. Schaefer-Graf; Thomas A. Buchanan; Anny Xiang; Giuliana Songster; Martin Montoro; Siri L. Kjos

2000-01-01

154

A Prospective Controlled Study of Neonatal Morbidities in Infants Born at 36 Weeks or More Gestation to Women with Diet-controlled Gestational Diabetes (GDM-class Al)  

Microsoft Academic Search

OBJECTIVE: Infants of gestational diabetes mellitus (GDM)-A1 women are unlikely to experience the marked excursion in maternal glucose levels that may characterize insulin-requiring GDM (class-A2) or insulin-dependent diabetes (IDDM). However, infants born to GDM-A1 women are traditionally managed like infants born to GDM-A2 or IDDM women.AIMS: To examine monitoring protocols for infants of GDM-A1 women, and to examine the efficacy

Subrata Sarkar; Jerry Watman; Warren M Seigel; Henry A Schaeffer

2003-01-01

155

Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus  

Microsoft Academic Search

ObjectiveTo compare Continuous Glucose Monitoring System (CGMS®) with self-monitoring of plasma glucose (SM) in detecting patients with gestational diabetes mellitus (GDM) needing antidiabetic drug treatment.

Kirsimarja K. Kestilä; Ulla U. Ekblad; Tapani Rönnemaa

2007-01-01

156

Serum fibroblast growth factor 21 levels in gestational diabetes mellitus in relation to insulin resistance and dyslipidemia  

Microsoft Academic Search

Fibroblast growth factor 21 (FGF21) has beneficial effects on glucose homeostasis and insulin sensitivity. In the current study, we investigated serum concentrations of FGF21 in patients with gestational diabetes mellitus (GDM) as compared with healthy pregnant controls matched for gestational age and fasting insulin. Fibroblast growth factor 21 was determined by enzyme-linked immunosorbent assay in control (n = 80) and

Sebastian Stein; Holger Stepan; Jürgen Kratzsch; Michael Verlohren; Hans-Joachim Verlohren; Kathrin Drynda; Ulrike Lössner; Matthias Blüher; Michael Stumvoll; Mathias Fasshauer

2010-01-01

157

Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus  

Microsoft Academic Search

Objective: The purpose of this study was to identify which maternal, antepartum, or neonatal clinical parameters were predictive for a high risk of diabetes mellitus in the puerperium in women with recent gestational diabetes mellitus and to calculate the associated diabetes mellitus rates and odds ratios. Study design: One thousand six hundred thirty-six women underwent an oral glucose tolerance test

Ute M. Schaefer-Graf; Thomas A. Buchanan; Anny H. Xiang; Ruth K. Peters; Siri L. Kjos

2002-01-01

158

Costs and consequences of treatment for mild gestational diabetes mellitus – evaluation from the ACHOIS randomised trial  

Microsoft Academic Search

BACKGROUND: Recommended best practice is that economic evaluation of health care interventions should be integral with randomised clinical trials. We performed a cost-consequence analysis of treating women with mild gestational diabetes mellitus by dietary advice, blood glucose monitoring and insulin therapy as needed compared with routine pregnancy care, using patient-level data from a multi-centre randomised clinical trial. METHODS: Women with

John R Moss; Caroline A Crowther; Janet E Hiller; Kristyn J Willson; Jeffrey S Robinson

2007-01-01

159

Gestational Diabetes: Using a Portable Glucometer to Simplify the Approach to Screening  

Microsoft Academic Search

Background: In populations at a high-risk for gestational diabetes (GDM), the recommendation of screening every pregnant woman with the oral glucose tolerance test (OGTT) is very demanding. Aim: To assess the usefulness of the portable, plasma optimized glucometer in simplifying the approach to screening of GDM. Methods: 1,662 pregnant women underwent the one-step 75 g OGTT for routine screening of

Mukesh M. Agarwal; Gurdeep S. Dhatt; Mohamed-Faouzi Safraou

2008-01-01

160

Agreement Between Self-Report and Birth Certificate for Gestational Diabetes Mellitus: New York State PRAMS  

Microsoft Academic Search

This study examined agreement (concordance or convergent validity) between self-report and birth certificate for gestational\\u000a diabetes. Study population was 2,854 women who had live births 2–6 months earlier and responded to a questionnaire from the\\u000a New York State Pregnancy Risk Assessment Monitoring System (PRAMS) survey, 2004–2006. Agreement between self-report and birth\\u000a certificate was assessed for the study population overall, and for

Akiko S. HoslerSeema; Seema G. Nayak; Anne. M. Radigan

2010-01-01

161

Extremely elevated activity of serum alkaline phosphatase in gestational diabetes: a case report.  

PubMed

We report a case of a 25-year-old pregnant woman with gestational diabetes and increased activity (25-fold) of placental isozyme of alkaline phosphatase. Abdominal ultrasonographic scan revealed no hepatobiliary disease. After delivery, the alkaline phosphatase level decreased but did not return to the reference range. Similar abnormalities were found in the patient's first-degree relatives, which included a mother and a sister. PMID:14981410

Wojcicka-Bentyn, Janina; Czajkowski, Krzysztof; Sienko, Jacek; Grymowicz, Monika; Bros, Magdalena

2004-02-01

162

Ethnic Differences in the Association Between Gestational Diabetes and Pregnancy Outcome  

Microsoft Academic Search

The purpose of the study was to examine ethnic variation in the impact of Gestational Diabetes Mellitus (GDM) on birth outcome.\\u000a The authors examined the association between GDM and pregnancy-induced hypertension, macrosomia, primary Cesarean delivery,\\u000a and preterm birth, using New York City Birth Certificate data from 2001–2006. Logistic regression was used to evaluate the\\u000a crude and adjusted odds ratios of

M. Mocarski; D. A. Savitz

163

The Effects of Carbohydrate Restriction in Patients With Diet-Controlled Gestational Diabetes  

Microsoft Academic Search

Objective: To determine the effect of carbohydrate restriction on perinatal outcome in patients with diet-controlled gestational diabetes mellitus (GDM).Methods: Women with diet-controlled GDM were divided non-randomly into two groups based on their dietary carbohydrate content: those with low dietary carbohydrate content (below 42%) and those with high dietary carbohydrate content (exceeding 45%). Subjects kept dietary accounts and were followed with

Carol A Major; M. Joann Henry; Margarita de Veciana; Mark A Morgan

1998-01-01

164

Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome  

Microsoft Academic Search

Objective: To assess whether metformin safely reduced development of gestational diabetes in women with the polycystic ovary syndrome (PCOS).Design: Prospective and retrospective study.Setting: Outpatient clinical research center.Patient(s): The prospective study included 33 nondiabetic women with PCOS who conceived while taking metformin and had live births; of these, 28 were taking metformin through delivery. The retrospective study included 39 nondiabetic women

C. J Glueck; Ping Wang; Suichi Kobayashi; Harvey Phillips; Luann Sieve-Smith

2002-01-01

165

Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes.  

PubMed

Diabetes during pregnancy may be associated with a high rate of congenital anomalies, disturbances of intrauterine growth and often post-natal neurobehavioral abnormalities in the offspring. The latter are associated with pregestational (PGD) as well as with gestational diabetes (GD). In this review we discuss the effects of maternal glucose intolerance on the long-term growth and development of the offspring. In well-controlled diabetes, birth weight is often within normal limits while in partially controlled diabetes newborns are often macrosomic. In PGD mothers with nephropathy, newborns tend to be born prematurely and small for gestational age (SGA). Offspring of diabetic mothers are often large and overweight in comparison to controls. Their long-term development is sometimes impaired. Delayed brain maturity is often observed in newborns of diabetic mothers compared to controls. The IQ scores of the children born to well controlled diabetic mothers are generally similar to that of control children. However, these children perform less well than controls in fine and gross motor functions. They also seem to have a higher rate of inattention and/or hyperactivity as observed by various tests and questionnaires. In our studies we found, in accordance with published literature, a negative correlation between the performance of the children born to mothers with PGD or GD on various neurodevelopmental and behavioral tests and the severity of maternal hyperglycemia as assessed by blood glycosylated hemoglobin levels and acetonuria. In conclusion: PGD or GD may adversely affect intrauterine and postnatal growth, attention span and motor functions of the offspring, but not their cognitive ability unless complicated by nephropathy or hypertension. These effects are negatively correlated with the degree of maternal glycemic control. PMID:16361984

Ornoy, Asher

2005-12-01

166

Gestational glucose tolerance and risk of type 2 diabetes in young Pima Indian offspring.  

PubMed

The in utero environment is a powerful risk factor for type 2 diabetes in offspring, but little is known about the risk conveyed by nondiabetic gestational glucose levels. This issue was explored in 911 nondiabetic Pima Indian mothers and 1,436 of their children. Associations were assessed in multivariate models between maternal third trimester glucose tolerance and indexes of body composition and glycemic control in their children. At parturition, the mothers' ages ranged from 14 to 43 years. Offspring were studied at age 0-39 years. An SD (1.3 mmol/l) of maternal glucose was associated with 56 g higher birth weight (P = 0.0002). This effect persisted when only offspring of normal glucose tolerant mothers were examined (57 g, P < 0.0001). In Cox proportional hazards models, the adjusted hazard rate ratio for offspring risk of diabetes per SD maternal glucose was 1.6 (95% CI 1.3-2.0, P < 0.0001). When only offspring of normal glucose tolerant mothers were examined, the risk was reduced but remained significant (1.3 [1.04-1.71], P = 0.026). In conclusion, maternal glycemia during pregnancy is associated with increased birth weight and risk of diabetes in Pima Indian offspring, even when mothers are normal glucose tolerant during pregnancy. Thus, prevention of offspring type 2 diabetes may require strategies that focus on improving gestational glucose tolerance even within the normal range. PMID:16443781

Franks, Paul W; Looker, Helen C; Kobes, Sayuko; Touger, Leslie; Tataranni, P Antonio; Hanson, Robert L; Knowler, William C

2006-02-01

167

[Self-care deficiencies in patients with gestational diabetes mellitus: a contribution to nursing].  

PubMed

Gestational diabetes mellitus can be controlled and its complications prevented, provided clients take part in self-care actions. The objective of the present study was to identify self care deficiencies in pregnant women suffering from diabetes, and to provide inputs for their educational support. This descriptive study included 12 pregnant women cared at a diabetes and hypertension reference institution in Fortaleza, Ceará, Brazil, in April and May, 2007. Data were collected using a semistructured interview. Analysis was based on Orem's Nursing General Theory. Self-care deficiencies were related to eating habits, physical activities, sleep and rest, and social interaction. Nurses must provide educational support to these patients, evaluate their self-care capacity, and propose actions that involve the family, as well as group activities in health services. PMID:19068573

Landim, Camila Aparecida Pinheiro; Milomens, Kallyne Moreira Pequeno; Diógenes, Maria Albertina Rocha

2008-09-01

168

Growth factor concentrations and their placental mRNA expression are modulated in gestational diabetes mellitus: possible interactions with macrosomia  

Microsoft Academic Search

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. GDM is a well known risk factor for foetal overgrowth, termed macrosomia which is influenced by maternal hypergycemia and endocrine status through placental circulation. The study was undertaken to investigate the implication of growth factors and their receptors in GDM and macrosomia, and to discuss the

Oussama Grissa; Akadiri Yessoufou; Inès Mrisak; Aziz Hichami; Daniel Amoussou-Guenou; Abir Grissa; François Djrolo; Kabirou Moutairou; Abdelhedi Miled; Hédi Khairi; Monia Zaouali; Iheb Bougmiza; Aabdelkarim Zbidi; Zouheir Tabka; Naim A Khan

2010-01-01

169

Prospective Study of Pre-Gravid Sugar Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus  

Microsoft Academic Search

OBJECTIVE — Consumption of sugar-sweetened beverages (SSBs) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older- aged populations. Studies on SSB consumption and glucose intolerance among pregnant women, however, are lacking. We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes

LIWEI CHEN; FRANK B. HU; EDWINA YEUNG; WALTER WILLETT; CUILIN ZHANG

2009-01-01

170

Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes. Evidence Report/Technology Assessment Number 162.  

National Technical Information Service (NTIS)

We focused on four questions: (1) What are the risks and benefits of an oral diabetes agent (i.e., glyburide), as compared to all types of insulin, for gestational diabetes (2) What is the evidence that elective labor induction, cesarean delivery, or timi...

2008-01-01

171

Weight loss after diagnosis with gestational diabetes and birth weight among overweight and obese women.  

PubMed

To determine if, among overweight or obese women with gestational diabetes (GDM), weight loss after GDM diagnosis is associated with lower infant birth weight within levels of overweight or obesity class. Overweight and obese women with singleton pregnancies managed for GDM at a large diabetes and pregnancy program located in Charlotte, NC between November 2000 and April 2010, were eligible for this retrospective cohort study. All were managed using a rigorous standardized clinical protocol. Clinical information including maternal pre-pregnancy body mass index, gestational weight gain, treatment, and medical and obstetric history was abstracted from medical records. The association of weight loss after GDM diagnosis and birth weight was analyzed using linear regression stratified by maternal pre-pregnancy overweight or obesity class (I, II/III). Of the 322 women in this study 19 % lost weight between diagnosis of GDM and delivery. After adjustment for maternal age, parity, race/ethnicity, gestational week at first hemoglobin A1c (A1C), A1C at diagnosis, weight gain prior to GDM, treatment with insulin or oral hypoglycemic agents, gestational age at delivery, and infant sex, weight loss was associated with 238.3 g lower mean infant birth weight among overweight women (95 % CI -393.72, -82.95 g), but was not associated with lower mean infant birth weight among obese class II/III women (95 % CI -275.61, 315.38 g). Weight loss, after diagnosis of GDM, is associated with lower infant birth weight among overweight women, but not among obese class II/III women. PMID:22692470

Katon, Jodie; Reiber, Gayle; Williams, Michelle A; Yanez, David; Miller, Edith

2013-02-01

172

Maternal Endothelin1 and Cyclic Guanosine Monophosphate Concentrations in Pregnancies Complicated by Pregravid and Gestational Diabetes Mellitus  

Microsoft Academic Search

Background\\/Aims: Pregnancy complicated by diabetes is associated with increased risk of unfavorable obstetric outcomes. A common abnormality in diabetes is endothelial dysfunction resulting in an altered pattern of vasoactive substance production by the endothelial cells. The aim of study was to assess serum endothelin-1 (ET-1) and cyclic guanosine monophosphate (cGMP) in pregnant women with pregravid (PGDM) or gestational diabetes (GDM).

Zbigniew Celewicz; Tomasz Miazgowski

2010-01-01

173

Correcting for ethnicity when defining large for gestational age infants in diabetic pregnancies.  

PubMed

The large-for-gestational-age (LGA) infant, defined as > 90th birthweight percentile, is associated with mild disturbances of maternal glucose tolerance. In the UK the same birthweight percentile charts are used for all ethnic groups when assessing LGA infants. The influence of maternal hyperglycaemia on LGA infants of Asian (Indian Subcontinent) mothers in the UK is likely to be under-reported, as Asian birthweights tend to be lower than White/Europid birthweights. We assessed the number of LGA infants born consecutively to 21 Asian and 26 White/Europid mothers with gestational diabetes mellitus (GDM), delivered between 37 and 42 weeks gestation, and also in 34 Asian and 121 White/Europid mothers with a positive screening test for GDM but a normal 75 g oral glucose tolerance test (OGTT). Large-for-gestational-age infants were identified using both the standard UK percentile charts of the Medical Research Council and percentile charts constructed from 30,418 Asian and 162,477 White/Europid singleton births, delivered between 37 and 42 weeks gestation to non-diabetic mothers delivered in the North West Thames Region of England. The standard Medical Research Council percentile charts, compared with the ethnically derived charts, identified fewer LGA Asian (7/56 vs 15/56) but more White/Europid infants (33/147 vs 21/147). When correcting for ethnicity more Asian than White/Europid GDM mothers delivered LGA infants (9/21 vs 3/26, chi 2 = 4.76, p < 0.05). The maternal 2 h OGTT plasma glucose was a significant independent contributor to birthweight in the Asian (r2 = 0.319, p < 0.0005) but not the White/Europid infants, in whom gestational age and maternal height were significant independent contributors to birthweight (r2 = 0.158, p < 0.0001). We conclude that ethnic influences are important when defining LGA infants and that mild disturbances of maternal glycaemia have a greater influence on the birthweight of Asian than White/Europid infants. PMID:8689842

Dornhorst, A; Nicholls, J S; Welch, A; Ali, K; Chan, S P; Beard, R W

1996-03-01

174

Evaluation of the serum leptin in normal pregnancy and gestational diabetes mellitus in Zahedan, southeast Iran  

Microsoft Academic Search

Purpose  There is conflicting data regarding leptin in gestational diabetes mellitus (GDM). The aim of the present study was to compare\\u000a serum leptin levels between individuals with GDM and normal pregnancy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This case–control study was performed on 26 GDM and 22 healthy pregnant women. Leptin concentrations were measured using an\\u000a enzyme immunoassay.\\u000a \\u000a \\u000a \\u000a \\u000a Results  The level of serum leptin was not significantly different

Mojgan Mokhtari; Mohammad Hashemi; Minoo Yaghmaei; Mohammad Naderi; Abdolsamad Shikhzadeh; Saeid Ghavami

175

Promoting breastfeeding among obese women and women with gestational diabetes mellitus.  

PubMed

Breastfeeding has many health benefits for women and their babies, but particularly if the woman is obese and/or had a pregnancy affected with gestational diabetes mellitus (GDM). Women who have had GDM are at high risk for developing metabolic syndrome or type 2 diabetes, and their offspring are at greater risk for these metabolic disorders both in childhood and later in adulthood. There is considerable evidence that breastfeeding may attenuate these risks. The aim of this article is to present the most recent evidence on what is known about how breastfeeding can mitigate the adverse metabolic effects of obesity and GDM on both mother and child, and describe best practices that can support and sustain breastfeeding, particularly in racial/ethnic communities at risk. PMID:21052873

Trout, Kimberly K; Averbuch, Tali; Barowski, Meghan

2011-02-01

176

Clinical usefulness of estimation of serum fructosamine concentration as screening test for gestational diabetes.  

PubMed

Serum fructosamine levels and fructosamine/protein ratios were measured in 100 pregnant women who underwent glucose tolerance tests because of clinical risk. Compared with normal pregnant women, the 13 study participants with gestational diabetes had higher fructosamine/protein levels (39 +/- 3.9 mumol/gm versus 37 +/- 3.2 mumol/gm, p less than 0.05), fasting serum glucose levels (107 +/- 13.7 mg/dl versus 82 +/- 8.6 mg/dl, p less than 0.001), and area under curve of glucose tolerance test (36 +/- 5 gm x min x dl-1 versus 22 +/- 3.6 gm x min x dl-1, p less than 0.001). The serum fructosamine levels were not significantly different between the two groups of participants (2.3 +/- 0.26 mmol/L versus 2.2 +/- 0.17 mmol/L); 10 of the 13 women with diabetes had a fructosamine/protein ratio within 2 SD of the mean of the groups of normal pregnant women. Spontaneous caloric intakes (r = 0.72, p less than 0.005) and the hospital mean daily capillary glucose levels during diabetic diet (r = 0.72, p less than 0.005) correlated better with the fructosamine/protein ratio than with fasting serum glucose levels (r = 0.58, p less than 0.05) and area under curve (r = 0.57, p less than 0.05). Consequently, serum fructosamine and fructosamine/protein ratio levels should be considered insensitive as a screening test in pregnant patients with clinical risk of gestational diabetes. PMID:2929687

Comtois, R; Desjarlais, F; Nguyen, M; Beauregard, H

1989-03-01

177

Morphometric study of placental villi and vessels in women with mild hyperglycemia or gestational or overt diabetes  

Microsoft Academic Search

In this study, morphometric measures of placental terminal villi and villous vessels were compared in overt, as well as gestational diabetes mellitus, and mild hyperglycemia diagnosed by oral 100g glucose tolerance test (100g-OGTT) and glucose profile (GP). At delivery (gestational age?34 weeks) a total of 207 placentas were assigned to a control group (n=56) or to one of three groups

Iracema M. P. Calderon; Débora C. Damasceno; Renée L. Amorin; Roberto A. A. Costa; Maria A. M. Brasil; Marilza V. C. Rudge

2007-01-01

178

Evaluation of Serum Selenium Levels in Turkish Women with Gestational Diabetes Mellitus, Glucose Intolerants, and Normal Controls  

Microsoft Academic Search

The aim of the study was to investigate the association between serum selenium levels in patients with gestational diabetes\\u000a mellitus (GDM) and glucose intolerants and compare them with those of glucose-tolerant pregnant women. This cross-sectional\\u000a study was prospectively performed in a total of 178 pregnant women undergoing a 50-g oral glucose tolerance test between 24\\u000a and 28 weeks of gestation who

Metin Kilinc; Melih A. Guven; Muhsin Ezer; Ibrahim Egemen Ertas; Ayhan Coskun

2008-01-01

179

Diabetes  

MedlinePLUS

... It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes. A blood test can show ...

180

Gestational Diabetes Mellitus: Screening and Outcomes in Southern Italian Pregnant Women  

PubMed Central

Recent Italian guidelines exclude women <35 years old, without risk factors for gestational diabetes mellitus (GDM), from screening for GDM. To determine the effectiveness of these measures with respect to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, we evaluated 2,448 pregnant women retrospectively enrolled in Calabria, southern Italy. GDM was diagnosed following the IADPSG 2010 criteria. Among 538 women <35 years old, without risk factors, who would have not been tested according to the Italian guidelines, we diagnosed GDM in 171 (31.8%) pregnants (7.0% of total pregnants). Diagnosis was made at baseline (55.6%), 1 hour (39.8%), or 2 hours (4.7%) during OGTT. Despite of appropriate treatment, GDM represented a risk factor for cesarean section, polyhydramnios, increased birth weight, admission to neonatal intensive care units, and large for gestational age. These outcomes were similar to those observed in GDM women at high risk for GDM. In conclusion, Italian recommendations failed to identify 7.0% of women with GDM, when compared to IADPSG criteria. The risk for adverse hyperglycaemic-related outcomes is similar in low-risk and high-risk pregnants with GDM. To limit costs of GDM screening, our data suggest to restrict OGTT to two steps (baseline and 1 hour).

Capula, Carmelo; Vero, Anna; Arcidiacono, Biagio; Iiritano, Stefania; Puccio, Luigi; Pullano, Vittorio; Foti, Daniela P.; Brunetti, Antonio; Vero, Raffaella

2013-01-01

181

Gestational diabetes mellitus: screening and outcomes in southern italian pregnant women.  

PubMed

Recent Italian guidelines exclude women <35 years old, without risk factors for gestational diabetes mellitus (GDM), from screening for GDM. To determine the effectiveness of these measures with respect to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, we evaluated 2,448 pregnant women retrospectively enrolled in Calabria, southern Italy. GDM was diagnosed following the IADPSG 2010 criteria. Among 538 women <35 years old, without risk factors, who would have not been tested according to the Italian guidelines, we diagnosed GDM in 171 (31.8%) pregnants (7.0% of total pregnants). Diagnosis was made at baseline (55.6%), 1 hour (39.8%), or 2 hours (4.7%) during OGTT. Despite of appropriate treatment, GDM represented a risk factor for cesarean section, polyhydramnios, increased birth weight, admission to neonatal intensive care units, and large for gestational age. These outcomes were similar to those observed in GDM women at high risk for GDM. In conclusion, Italian recommendations failed to identify 7.0% of women with GDM, when compared to IADPSG criteria. The risk for adverse hyperglycaemic-related outcomes is similar in low-risk and high-risk pregnants with GDM. To limit costs of GDM screening, our data suggest to restrict OGTT to two steps (baseline and 1 hour). PMID:24093064

Capula, Carmelo; Chiefari, Eusebio; Vero, Anna; Arcidiacono, Biagio; Iiritano, Stefania; Puccio, Luigi; Pullano, Vittorio; Foti, Daniela P; Brunetti, Antonio; Vero, Raffaella

2013-09-05

182

Prevention of Diabetes in Women with a History of Gestational Diabetes: Effects of Metformin and Lifestyle Interventions  

PubMed Central

Context: A past history of gestational diabetes mellitus (GDM) confers a very high risk of postpartum development of diabetes, particularly type 2 diabetes. Objective: The Diabetes Prevention Program (DPP) sought to identify individuals with impaired glucose tolerance (IGT) and intervene in an effort to prevent or delay their progression to diabetes. This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM. Design: The DPP was a randomized, controlled clinical trial. Setting: The study was a multicenter, National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites. Patients: A total of 2190 women were randomized into the DPP and provided information for past history of GDM. This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM. Interventions: Subjects were randomized to either standard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention. Main Outcomes: The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing. Assessments of insulin secretion and insulin sensitivity were also performed. Results: Whereas entering the study with similar glucose levels, women with a history of GDM randomized to placebo had a crude incidence rate of diabetes 71% higher than that of women without such a history. Among women reporting a history of GDM, both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50% compared with the placebo group, whereas this reduction was 49 and 14%, respectively in parous women without GDM. These data suggest that metformin may be more effective in women with a GDM history as compared with those without. Conclusions: Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline. Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM.

Ratner, Robert E.; Christophi, Costas A.; Metzger, Boyd E.; Dabelea, Dana; Bennett, Peter H.; Pi-Sunyer, Xavier; Fowler, Sarah; Kahn, Steven E.

2008-01-01

183

A Randomized Controlled Trial of Prenatal Physical Activity to Prevent Gestational Diabetes: Design and Methods  

PubMed Central

Abstract Background Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, currently at epidemic rates in the United States. GDM, therefore, identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder. It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes. To date, however, primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder. Methods The aims of this study are to investigate the effects of a motivationally targeted, individually tailored 12-week physical activity intervention on (1) development of GDM, (2) serum biomarkers associated with insulin resistance, and (3) the adoption and maintenance of exercise during pregnancy. Women at high risk of GDM are recruited in early pregnancy and randomized to either an individually tailored exercise intervention or a comparison health and wellness intervention. Results The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle. Conclusions The intervention takes into account the specific social, cultural, economic, and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic backgrounds.

Marcus, Bess H.; Stanek, Edward; Ciccolo, Joseph T.; Marquez, David X.; Solomon, Caren G.; Markenson, Glenn

2009-01-01

184

Breast-feeding is associated with reduced postpartum maternal glucose intolerance after gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is associated with adverse foetal and maternal outcomes, and identifies women at risk of future Type 2 Diabetes Mellitus (T2DM). Breast-feeding may improve postpartum maternal glucose tolerance. We prospectively examined the prevalence of postpartum dysglycaemia after GDM and examined the effect of lactation on postpartum glucose tolerance. We compared postpartum 75g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT). Breast-feeding data was collected at time of OGTT. Postpartum OGTT results were classified as normal [fasting plasma glucose (FPG) < 5.6mmol/l, 2-h < 7.8 mmol/l] and abnormal [impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2-h glucose 7.8-11 mmol/l; IFG+IGT; T2DM, FPG > or = 7 mmol/l +/- 2h glucose > or = 11.1 mmol/l]. 6 (2.7%) with NGT in pregnancy had postpartum dysglycaemia compared to 57 (19%) with GDM in index pregnancy (p < 0.001). Non-European ethnicity (OR 3.40, 95% CI 1.45-8.02, p = 0.005), family history of T2DM (OR 2.14, 95% CI 1.06-4.32, p = 0.034) and gestational insulin use (OR 2.62, 95% CI 1.17-5.87 p = 0.019) were associated with persistent dysglycaemia. The prevalence of persistent hyperglycaemia was significantly lower in women who breast-fed versus bottle-fed postpartum (8.2% v 18.4%, p < 0.001). Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged. PMID:22838108

O'Reilly, M; Avalos, G; Dennedy, M C; O'Sullivan, E P; Dunne, F P

2012-05-01

185

Diet-induced impaired glucose tolerance and gestational diabetes in the dog.  

PubMed

Glucose metabolism was compared in dogs consuming a chow/meat diet throughout pregnancy (P group, n = 6) and dogs switched to a high-fat/high-fructose (HFF) diet during the 4th-5th gestational week (gestation ?9 wk; P-HFF group; n = 6). An oral glucose tolerance test (OGTT; 0.9 g/kg) was administered in the 6th-7th gestational week, and a hyperinsulinemic [0-120 min: 1.8 pmol·kg(-1)·min(-1) (low insulin); 120-240 min: 9 pmol·kg(-1)·min(-1) (high insulin)] euglycemic clamp was performed the following week. Nonpregnant (NP) female dogs underwent OGTTs but not clamp studies. All P-HFF dogs exhibited impaired glucose tolerance (IGT) or gestational diabetes (GDM), but only one P dog had IGT. Insulin concentrations in P and P-HFF dogs were significantly lower than in NP dogs 30 and 60 min after the OGTT. Therefore, mean islet size and area were evaluated in P and NP dogs. These values did not differ between groups, and proliferating endocrine cells were rare in pregnancy. During exposure to high insulin, glucose infusion rate and hindlimb glucose uptake were ?30% greater (P < 0.05) and net hepatic glucose output was more suppressed (-5.5 ± 6.1 vs. 7.8 ± 2.8 mg·100 g liver(-1)·min(-1), P < 0.05) in P than in P-HFF dogs. In conclusion, in the 2nd trimester the canine pancreas does not exhibit islet hypertrophy, hyperplasia, or neogenesis. Combined with the lack of pancreatic adaptation, a HFF diet during late pregnancy produces a canine model of IGT and GDM without hyperinsulinemia but exhibiting liver and muscle insulin resistance. PMID:21088210

Moore, Mary Courtney; Menon, Renuka; Coate, Katie C; Gannon, Maureen; Smith, Marta S; Farmer, Ben; Williams, Phillip E

2010-11-18

186

Disproportionate body composition and neonatal outcome in offspring of mothers with and without gestational diabetes mellitus.  

PubMed

OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998-2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm(3)) was ?90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0-3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09-1.30]) and hypoglycemia (1.23 [1.11-1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA. PMID:24159180

Persson, Martina; Fadl, Helena; Hanson, Ulf; Pasupathy, Dharmintra

2013-11-01

187

Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours  

PubMed Central

Background Diabetes is increasing in prevalence globally, notably amongst populations from low- and middle- income countries. Gestational Diabetes Mellitus(GDM), a precursor for type 2 diabetes, is increasing in line with this trend. Few studies have considered the personal and social effects of GDM on women living in low and middle-income countries. The aim of this study was determine attitudes and health behaviours of pregnant women with GDM in Vietnam. Methods This was a qualitative study using focus group methodology conducted in Ho Chi Minh City. Pregnant women, aged over 18 years, with GDM were eligible to participate. Women were purposely sampled to obtain a range of gestational ages and severity of disease. They were invited to attend a 1-hour focus group. Questions were semi structured around six themes. Focus groups were recorded, transcribed, translated and cross-referenced. Non-verbal and group interactions were recorded. Thematic analysis was performed using a theoretical framework approach. Results From December 2010 to February 2011, four focus groups were conducted involving 34 women. Median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. Women felt confusion, anxiety and guilt about GDM. Many perceived their baby to be at increased risk of death. Advice to reduce dietary starch was confusing. Women reported being ‘hungry’ or ‘starving’ most of the time, unaware of appropriate food substitutions. They were concerned about transmission of GDM through breast milk. Several women planned not to breastfeed. All felt they needed more information. Current sources of information included friends, magazines, a health phone line or the Internet. Women felt small group sessions and information leaflets could benefit them. Conclusions This study highlights the need for culturally appropriate clinical education and health promotion activities for women with GDM in Vietnam.

2012-01-01

188

When is fasting really fasting? The influence of time of day, interval after a meal, and maternal body mass on maternal glycemia in gestational diabetes  

Microsoft Academic Search

Objective: The object of the study was to determine whether time of day, interval after a standard meal, and maternal body mass influence plasma glucose concentrations in women with gestational diabetes mellitus. Study Design: Identical mixed meals were administered on 2 separate occasions 1 week apart to 30 women with dietarily treated gestational diabetes and pregnancies between 28 and 38

David A. Sacks; Wansu Chen; Girma Wolde-Tsadik; Thomas A. Buchanan

1999-01-01

189

Clinical impact of mild carbohydrate intolerance in pregnancy: A study of 2904 nondiabetic Danish women with risk factors for gestational diabetes mellitus  

Microsoft Academic Search

Objective: The objective was to study the clinical impact of mild carbohydrate intolerance in pregnant women with risk factors for gestational diabetes mellitus. Study Design: This was a historical cohort study of 2904 pregnant women examined for gestational diabetes on the basis of risk factors. Information on oral glucose tolerance test results and clinical outcomes was collected from laboratory charts

Dorte M. Jensen; Peter Damm; Bente Sørensen; Lars Mølsted-Pedersen; Jes G. Westergaard; Joachim Klebe; Henning Beck-Nielsen

2001-01-01

190

Screening, diagnosis and services for women with gestational diabetes mellitus (GDM) in New Zealand: a technical report from the National GDM Technical Working Party  

Microsoft Academic Search

Rates of gestational diabetes mellitus (GDM) and Type 2 diabetes in pregnancy are increasing with the epidemic of obesity. GDM is associated with significant perinatal morbidity and future risk of permanent diabetes in the mother and obesity and diabetes in the offspring. The recent Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) has shown maternal and perinatal benefits of managing

David Simmons; Janet Rowan; Rosemary Reid; Norma Campbell

191

Antenatal haemoglobin A1c and risk of large-for-gestational-age infants in a multi-ethnic cohort of women with gestational diabetes.  

PubMed

Gestational diabetes mellitus (GDM) is a risk factor for delivering a large-for-gestational-age (LGA) infant. Haemoglobin A1c (A1C) is an indicator of glycaemic control. The objective of this study was to test whether higher A1C quartile at the time of diagnosis of GDM is associated with increased risk of delivering a LGA or macrosomic infant. Women with singleton pregnancies treated for GDM at a large diabetes and pregnancy programme located in Charlotte, North Carolina, were eligible for inclusion in this retrospective cohort study. Clinical information, including A1C at diagnosis, treatment, prior medical and obstetric history, and birth data were abstracted from medical records. LGA was defined as birthweight >90th percentile for gestational age and sex and macrosomia as birthweight >4000?g. Logistic regression was used to analyse the association of A1C at GDM diagnosis with risk of delivering LGA or macrosomic infants. This study included 502 women. Prevalences of LGA and macrosomia were 4% and 6% respectively. After adjustment there was no detectable trend of increased risk for LGA (P for trend?=?0.12) or macrosomia (P for trend?=?0.20) across increasing quartiles of A1C at GDM diagnosis. A1C at GDM diagnosis may not be linearly associated with LGA or macrosomia, possibly because of the mediating effect of strict glycaemic control in this clinical setting. PMID:22471680

Katon, Jodie; Reiber, Gayle; Williams, Michelle A; Yanez, David; Miller, Edith

2012-03-07

192

Achieving euglycaemia in women with gestational diabetes mellitus: current options for screening, diagnosis and treatment.  

PubMed

Gestational diabetes mellitus is one of the major medical complications of pregnancy. Untreated, the mother and the unborn child may experience morbidity and fetal death may even occur. It is important to diagnose and treat all hyperglycaemia appearing during pregnancy. Ideally, a screening and diagnostic test that identified all women at risk for hyperglycaemia-associated complications would be employed in all pregnant women. Unfortunately, there is no such test available currently. The best alternative is to administer an oral glucose challenge test to all pregnant women and then apply the best strategies for interpretation. This article discusses the limitations of our present diagnostic tools and suggests an option for the clinician until the definitive test has been elucidated. In addition, this article outlines one dietary and management strategy that has been associated with an outcome of pregnancy that is similar to the outcome of pregnancies in healthy women. This strategy includes starting with a "euglycaemic" diet (comprising < 40% carbohydrates and > or =40% fat), which can then be individualised according to the patient's glucose levels. Appropriate exercise, such as arm ergometer training, may enhance the benefits of diet control. For patients who require insulin, if the fasting glucose level is >90 mg/dL or 5 mmol/L (whole blood capillary) then NPH insulin (insulin suspension isophane) should be given before bed, beginning with dosages of 0.2 U/kg/day. If the postprandial glucose level is elevated, pre-meal rapid-acting insulin should be prescribed, beginning with a dose of 1U per 10g of carbohydrates in the meal. If both the fasting and postprandial glucose levels are elevated, or if a woman's postprandial glucose levels can only be blunted if starvation ketosis occurs, a four-injections-per-day regimen should be prescribed. The latter can be based on combinations of NPH insulin and regular human insulin, timed to provide basal and meal-related insulin boluses. The total daily insulin dose for the four-injection regimen should be adjusted according to pregnant bodyweight and gestational week (0.7-1 U/kg/day); doses may need to be increased for the morbidly obese or when there is twin gestation. There is now some evidence that insulin lispro, other insulin analogues and oral antihyperglycaemic drugs may be beneficial in gestational diabetes, and more data on these agents are awaited with interest. PMID:15212558

Jovanovic, Lois

2004-01-01

193

Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial  

PubMed Central

Background Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. Method/design A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI >25 to 29.9 k/gm2) or obese (BMI >30?kgm/2), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief ( less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000125729

2013-01-01

194

The role of exercise in reducing the risks of gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy and is particularly prevalent among obese women. Both GDM and obesity confer significant comorbidities for the mother and her offspring, including perinatal complications, excessive fetal growth and long-term risks for maternal and offspring obesity and diabetes. Exercise has well-documented health benefits and reduces peripheral insulin resistance in nonpregnant individuals, a major risk factor for the development of diabetes. Observational studies conducted in large population-based cohorts suggest that women who are the most active before pregnancy are less insulin-resistant in late pregnancy and have lower rates of GDM. This article will review the evidence supporting a role for exercise in the prevention of GDM, the management of glycemic control in women with established GDM, and the reduction of GDM-associated maternal and offspring health consequences. Wherever possible, the discussion will focus on studies carried out on obese women. However, there are many areas where strong evidence is lacking in obese populations, and it may be inferred from similar studies performed in normal weight pregnant women. PMID:24161309

Hopkins, Sarah A; Artal, Raul

2013-11-01

195

Is gestational diabetes mellitus an important contributor to metabolic disorders in trinidad and tobago?  

PubMed

Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend. PMID:19946648

Clapperton, M; Jarvis, J; Mungrue, K

2009-05-11

196

Is Gestational Diabetes Mellitus an Important Contributor to Metabolic Disorders in Trinidad and Tobago?  

PubMed Central

Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.

Clapperton, M.; Jarvis, J.; Mungrue, K.

2009-01-01

197

The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25-hydroxyvitamin D deficiency  

PubMed Central

OBJECTIVE: To assess the relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus in Turkish pregnant women according to the severity of 25-hydroxyvitamin D deficiency and assess intact parathyroid hormone levels in women with gestational diabetes mellitus and controls with low and sufficient 25-hydroxyvitamin D levels. METHODS: We analyzed serum 25-hydroxyvitamin D and intact parathyroid hormone levels in 234 women with gestational diabetes mellitus and 168 controls. To define the deficiency status, 25-hydroxyvitamin D levels were further classified into severely deficient, deficient, insufficient and sufficient groups. RESULTS: Women with gestational diabetes mellitus had significantly lower 25-hydroxyvitamin D levels compared to controls (30.8±16.3 vs. 36.0±16.2 nmol/L). However, when subgroups of 25-hydroxyvitamin D were analyzed, gestational diabetes mellitus was significantly more common only in women with severely deficient 25-hydroxyvitamin D levels. After adjusting for covariates, only severely deficient 25-hydroxyvitamin D levels were independently associated with an increased relative risk of gestational diabetes mellitus. The relative risk of gestational diabetes mellitus in women with insufficient and deficient 25-hydroxyvitamin D levels was not statistically significant. Intact parathyroid hormone concentrations were also significantly higher in women with gestational diabetes mellitus compared to the controls (45.3±26.2 vs. 38.7±27.6 pg/ml). CONCLUSIONS: The results obtained from this study provide novel data indicating that only severely deficient maternal serum 25-hydroxyvitamin D levels are significantly associated with an elevated relative risk of gestational diabetes mellitus, even after adjusting for established risk factors of gestational diabetes mellitus.

Zuhur, Sayid Shafi; Erol, Rumeysa Selvinaz; Kuzu, Idris; Altuntas, Yuksel

2013-01-01

198

Gestational diabetes among Bedouins in southern Israel: comparison of prevalence and neonatal outcomes with the Jewish population  

Microsoft Academic Search

Differences in the prevalence of gestational diabetes mellitus (GDM) have recently been reported between various ethnic populations. In the Negev region of Israel, a universal free screening programme for GDM was implemented in 1985. Between 1 March 1987 and 31 July 1988 11 003 deliveries occurred at the Soroka Medical Center, which provides free delivery and postnatal care to the

D. Fraser; S. Weitzman; J. R. Leiberman; E. Zmora; E. Laron; M. Karplus

1994-01-01

199

High Prevalence of Polycystic Ovaries and Associated Clinical, Endocrine, and Metabolic Features in Women with Previous Gestational Diabetes Mellitus  

Microsoft Academic Search

The prevalence of polycystic ovaries, according to ultrasonography, and associated clinical, endocrine, and metabolic features were in- vestigated in women with previous gestational diabetes mellitus (GDM). Thirty-four women with GDM 3-5 yr before the investigation and 36 controls with uncomplicated pregnancies, selected for similar age, parity, and date of delivery, were investigated. The women with previous GDM showed a higher

JAN HOLTE; GIANLUCA GENNARELLI; LEIF WIDE; HANS LITHELL; CHRISTIAN BERNE

2010-01-01

200

An Exploratory Mixed Method Assessment of Low Income, Pregnant Hispanic Women's Understanding of Gestational Diabetes and Dietary Change  

ERIC Educational Resources Information Center

|Objective: To describe and assess low income, healthy, pregnant Hispanic women's understanding of gestational diabetes (GDM) and willingness to change aspects of their diet. Design: One-on-one, in-person interviews conducted in Spanish with 94 women (primarily Mexican). Setting: Federal Qualified Community Health Center's prenatal clinic. Method:…

Rhoads-Baeza, Maria Elena; Reis, Janet

2012-01-01

201

Strategies for recruiting Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus  

Microsoft Academic Search

BACKGROUND: The purpose of this article was to describe effective strategies for recruitment of Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus (GDM). Although Hispanic women have two to four times the risk of developing GDM compared with non-Hispanic white women, few GDM prevention studies have included Hispanic women. METHODS: The study was

Lisa Chasan-Taber; Renée T Fortner; Valerie Hastings; Glenn Markenson

2009-01-01

202

Metabolic and Steroidogenic Alterations Related to Increased Frequency of Polycystic Ovaries in Women with a History of Gestational Diabetes  

Microsoft Academic Search

The prevalence of polycystic ovaries (PCO) and clinical, endocrine, and metabolic features were investigated in women with previous gestational diabetes (GDM). Thirty-three women with a history of GDM and 48 controls were studied. Glucose and insulin secretion capacity was evaluated by means of the oral glucose tolerance test (OGTT), and insulin action was determined by means of a euglycemic insulin

RIITTA M. KOIVUNEN; JAANA JUUTINEN; ILKKA VAUHKONEN; LAURE C. MORIN-PAPUNEN; AIMO RUOKONEN; JUHA S. TAPANAINEN

2010-01-01

203

Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up  

Microsoft Academic Search

BACKGROUND: Annual prevalence of gestational diabetes mellitus (GDM) is 12.5% among Finnish pregnant women. The prevalence is expected to rise with the increasing overweight among women before pregnancy. Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM. We aimed to investigate, whether GDM can be prevented by counseling

Riitta M Luoto; Tarja I Kinnunen; Minna Aittasalo; Katriina Ojala; Kirsi Mansikkamäki; Erja Toropainen; Päivi Kolu; Tommi Vasankari

2010-01-01

204

Perinatal Outcomes in Hispanic and Non-Hispanic White Women With Mild Gestational Diabetes  

PubMed Central

OBJECTIVE To compare perinatal outcomes between self-identified Hispanic and non-Hispanic white women with mild gestational diabetes mellitus (GDM) or glucose intolerance. METHODS In a secondary analysis of a mild GDM treatment trial, we compared perinatal outcomes by race and ethnicity for 767 women with glucose intolerance (abnormal 50g 1-hour screen, normal 100g 3-hour oral glucose tolerance test [OGTT]), 371 women with mild GDM assigned to usual prenatal care, and 397 women with mild GDM assigned to treatment. Outcomes included: composite adverse perinatal outcome (neonatal death, hypoglycemia, hyperbilirubinemia, hyperinsulinemia; stillbirth; birth trauma), gestational age at delivery, birthweight, and hypertensive disorders of pregnancy. Adjusted regression models included: 100g 3-hour OGTT results; parity; gestational age, body mass index, maternal age at enrollment; and current tobacco use. RESULTS The sample of 1535 women was 68.3% Hispanic and 31.7% non-Hispanic White. Among women with glucose intolerance, Hispanic women had more frequent composite outcome (37% vs. 27%, aOR 1.62 95%CI 1.10, 2.37), with more neonatal elevated C-cord peptide (19% vs. 13%, aOR 1.79 95%CI 1.04, 3.08) and neonatal hypoglycemia (21% vs. 13%, aOR 2.04 95%CI 1.18, 3.53). Among women with untreated mild GDM, outcomes were similar by race/ethnicity. Among Hispanic women with treated mild GDM, composite outcome was similar to non-Hispanic White women (35% vs. 25%, aOR 1.62 95% CI 0.92, 2.86), but Hispanic neonates had more frequent hyperinsulinemia (21% vs. 10%, aOR 2.96 95%CI 1.33, 6.60). CONCLUSION Individual components of some neonatal outcomes were more frequent in Hispanic neonates, but most perinatal outcomes were similar between Hispanic and non-Hispanic ethnic groups.

Berggren, Erica K.; Mele, Lisa; Landon, Mark B.; Spong, Catherine Y.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.

2012-01-01

205

Changes in sweet taste across pregnancy in mild gestational diabetes mellitus: relationship to endocrine factors.  

PubMed

Gestational diabetes mellitus (GDM) is glucose intolerance diagnosed during pregnancy. Previous work suggested that women with GDM showed exaggerated preferences for sweet taste, but data were limited to a single time point during pregnancy. This study longitudinally assessed sweet taste changes across pregnancy in women who developed GDM (n = 15) as compared with women with normal glucose tolerance (NGT; n = 93) and nonpregnant controls (n = 19). A second objective was to relate sweet taste changes in GDM to fasting leptin and insulin profiles. Following an overnight fast, subjects evaluated strawberry-flavored milks varying in sucrose and fat content, as well as glucose solutions. Evaluations were made at 3 time points during pregnancy and during early postpartum. At 34-38 weeks gestation, women with GDM gave higher liking ratings to moderately sweetened (5% and 10% sucrose) strawberry milks than women with NGT. These differences were not related to alterations in the perception of the samples. At 24-28 weeks gestation, and in women with GDM only, fasting insulin was correlated with liking of the glucose solutions (R(2) = 0.63, P = 0.004) and fasting leptin was correlated with sweetness liking of the 10% sucrose milk (R(2) = 0.42, P = 0.017). These data suggest that women with GDM exhibit higher liking ratings for a sweet fat milk drink late in pregnancy. Also, higher hedonic ratings for sweet taste in GDM may be related to elevated leptin and insulin concentrations at midpregnancy. GDM may increase the desire for sweet taste that could influence dietary management of this disease. PMID:19587026

Belzer, Lisa M; Smulian, John C; Lu, Shou-En; Tepper, Beverly J

2009-07-08

206

A pharmacoeconomical model for choice of a treatment for pregnant women with gestational diabetes.  

PubMed

This study discusses two main questions: the direct medical costs and the clinical effectiveness of the hospital treatment with insulin of pregnant women with gestational diabetes (GD). A prospective study that includes 50 women with GD is performed. The pregnant women are divided into 2 groups: Group I (n=30) - pregnant women treated only with a diet; and Group II (n=20) - pregnant women treated with diet and insulin. We found that the metabolite compensation degree is improved after the applied treatment with insulin. The coefficient cost/effectiveness is 6954 lv./100 women. The analysis decision tree confirms in a very convenient way the fact that insulin treatment is a clinically more effective and financially more profitable strategy. PMID:17721753

Todorova, K; Palaveev, O; Petkova, V B; Stefanova, M; Dimitrova, Zl

2007-08-26

207

The Effect of Race/Ethnicity on Adverse Perinatal Outcomes among Patients with Gestational Diabetes  

PubMed Central

OBJECTIVE To determine racial/ethnic differences in perinatal outcomes among women with gestational diabetes mellitus (GDM). STUDY DESIGN Retrospective cohort study of 32,193 singleton births among GDMs in California from 2006, using Vital Statistics Birth and Death Certificate and Patient Discharge Data. Women were divided by race/ethnicity: White, Black, Hispanic, or Asian. Multivariable logistic regression analyzed associations between race/ethnicity and adverse outcomes, controlling for potential confounders. Outcomes included: primary cesarean, preeclampisa, neonatal hypoglycemia, preterm delivery, macrosomia, fetal anomaly, respiratory distress syndrome (RDS). RESULTS Compared to other races, Black women had higher odds of preeclampsia [aOR=1.57, 95%CI(1.47-1.95)], neonatal hypoglycemia [aOR=1.79, 95%CI(1.07-3.00)], and preterm delivery <37 weeks [aOR=1.56, 95%CI(1.33-1.83)]. Asians had the lowest odds of primary cesarean [aOR=0.75, 95%CI(0.69-0.82)], large for gestational age infants [aOR=0.40, 95%CI(0.33-0.48)], and neonatal RDS [aOR=0.54, 95%CI(0.40-0.73)]. CONCLUSION Perinatal outcomes among women with GDM differ by race/ethnicity and may be attributed to inherent sociocultural differences that may impact glycemic control, the development of chronic co-morbidities, genetic variability, and variation in access to as well as quantity and quality of prenatal care.

NGUYEN, Brian T.; CHENG, Yvonne W.; SNOWDEN, Jonathan M.; ESAKOFF, Tania F.; FRIAS, Antonio E.; CAUGHEY, Aaron B.

2012-01-01

208

Antioxidant Vitamins and Lipoperoxidation in Non-pregnant, Pregnant, and Gestational Diabetic Women: Erythrocytes Osmotic Fragility Profiles  

PubMed Central

Background Inconsistent reports are available in the literature regarding the oxidative status and antioxidant capacity during the pathogenesis of gestational diabetes. Present study was aimed to evaluate oxidative stress during the development of gestational diabetes and to evaluate antioxidant capability in non-pregnant (control), pregnant and gestational diabetics. Methods The study consisted of non-pregnant, healthy pregnant and patients suffering from gestational diabetes mellitus (GDM). Each group consisted of 23 women. We compared their oxidative and anti-oxidative system in blood. Their blood malondialdehyde (MDA) and antioxidant vitamins (C, E, A) were determined and compared to evaluate the oxidative status and anti-oxidative capacity of these groups. We have also compared the osmotic fragility profiles of the erythrocytes of these groups. Results Plasma MDA content in pregnant was significantly higher compared to non-pregnant (p < 0.001, 67.5%) and even in gestational diabetics; its value was found significantly further elevated (p = 0.001, 13.8%) compared to healthy pregnant. There was significant decline (p < 0.001, 41.9%) in the level of vitamin C in pregnant as compared to non-pregnant. Although in GDM the decrease was significant (p = 0.025, 20.6%) but comparatively lesser when compared to healthy pregnant. Vitamin E showed the increase of 9.6% during pregnancy, although this alteration was non-significant (p = 0.09), but the level was found to decline significantly (p < 0.001, 25.5%) in GDM compared to pregnant group. Vitamin A contents were also decreased in pregnant (p = 0.002, 17.4%) compared to non-pregnant and in GDM (p = 0.012, 11.2%) compared to pregnant group. Osmotic fragility (O.F.) profiles showed insignificant (p = 0.325) enhanced mean erythrocyte fragility (MEF) in pregnant but this increase was significant (p = 0.003) in case of GDM. The O.F. profiles of pregnant and GDM erythrocytes got shifted to the right side of the control one. Conclusions Our findings indicate highly enhanced lipid peroxidation and significant depletion in antioxidant capacity during the development of gestational diabetes, and these alterations are not the cause but the consequence of GDM. However, further studies are warranted to examine a wider range of biochemical parameters to evaluate the potential risks of oxidative damage in GDM. Keywords Gestational diabetes; Oxidative stress; Anti-oxidants; Vitamins C, E, A; Osmotic fragility; Non-pregnant; Pregnant; GDM

Suhail, Mohd; Patil, Shridhar; Khan, Salma; Siddiqui, Sana

2010-01-01

209

Interpregnancy Weight Gain and Cesarean Delivery Risk in Women With a History of Gestational Diabetes  

PubMed Central

Objective Along with the rising prevalence of obesity, rates of gestational diabetes mellitus (GDM) and associated adverse outcomes have also increased. We conducted a population-based, retrospective cohort study to assess the association of weight gain between pregnancies with cesarean delivery for the subsequent pregnancy among women with a history of GDM. Methods Using linked birth certificate data for women with at least two singleton births in Washington State during 1992-2005, we identified 2,753 women with GDM who delivered vaginally at their baseline pregnancy (first pregnancy on record). The interpregnancy weight change (subsequent - baseline prepregnancy weight) for each woman was calculated and assigned to one of three categories: weight loss (>10 lbs), weight stable (±10 lbs), or weight gain (>10 lbs). Multiple logistic regression was used to calculate the risk (OR) of cesarean delivery at the subsequent pregnancy among the weight gain and weight loss groups relative to the weight-stable category. Results Among 2,581 eligible women, 10.9% lost more than10 lbs, 54.0% were weight-stable and 35.1% gained more than10 lbs between pregnancies. Women who gained more than 10 lbs had an adjusted OR for subsequent cesarean delivery of 1.70 (95% CI, 1.16-2.49; 9.7% of women who gained weight) while the adjusted OR for women who lost weight was 0.55 (95% CI, 0.28-1.10; 4.7% of women who lost weight). Conclusion Women with a history of GDM who gained greater than10 lbs between pregnancies were at increased risk of future cesarean delivery. Appropriate weight management among women with a history of GDM may result in decreased cesarean delivery rates along with associated excess risks and costs. Précis Women with a history of gestational diabetes mellitus who gain more than 10 lbs between pregnancies are at increased risk of future cesarean delivery.

Paramsothy, Pathmaja; Lin, Yvonne S.; Kernic, Mary A.; Foster-Schubert, Karen E.

2009-01-01

210

A parallel increase in placental oxidative stress and antioxidant defenses occurs in pre-gestational type 1 but not gestational diabetes.  

PubMed

We aimed to determine the oxidative stress status in placentas obtained from gestational (GDM) and type 1 (T1D) diabetic pregnancies. Malonaldehyde and protein carbonyls, two biomarkers of oxidative damage, were higher in T1D but not in GDM placentas. Also, higher reduced glutathione and lower oxidized glutathione levels and higher glutathione peroxidase activity were found in T1D but not in GDM placentas. These results suggest that T1D placentas may develop a protective antioxidant mechanism to overcome higher oxidative stress levels. PMID:24054539

Araújo, J R; Ramalho, C; Correia-Branco, A; Faria, A; Ferraz, T; Keating, E; Martel, F

2013-09-11

211

Antepartum glucose tolerance test results as predictors of type 2 diabetes mellitus in women with a history of gestational diabetes mellitus: A systematic review  

Microsoft Academic Search

Background: Women with a history of gestational diabetes mellitus (GDM) are at high risk for type 2 diabetes mellitus (T2DM).Objective: We reviewed prospective studies of antepartum glucose tolerance test results as risk factors for development of T2DM among women with a history of GDM.Methods: We searched 4 electronic databases and hand-searched 13 journals for literature published through January 2007. The

Sherita Hill Golden; Wendy L. Bennett; Kesha Baptist-Roberts; Lisa M. Wilson; Bethany Barone; Tiffany L. Gary; Eric Bass; Wanda K. Nicholson

2009-01-01

212

Social Support Modifies the Association Between Household Food Insecurity and Depression Among Latinos with Uncontrolled Type 2 Diabetes  

Microsoft Academic Search

Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify\\u000a the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that\\u000a protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment.\\u000a Multivariate logistic regression was used to

Grace Kollannoor-Samuel; Julie Wagner; Grace Damio; Sofia Segura-Pérez; Jyoti Chhabra; Sonia Vega-López; Rafael Pérez-Escamilla

213

Pregnancy glycemia in Mexican-American women without diabetes or gestational diabetes and programming for childhood obesity.  

PubMed

In the present study, we estimated the association between pregnancy glucose levels and offspring body mass index (BMI) z scores at 2, 3.5, 5, and 7 years of age, as well as z score trajectories across this age range, among Mexican-American women without diabetes or gestational diabetes. Beginning in 1999-2000, the Center for the Health Assessment of Mothers and Children of Salinas prospectively followed women from Monterey County, California (52 obese and 214 nonobese women) and their children. Plasma glucose values obtained 1 hour after a 50-g oral glucose load comprised the exposure. Offspring BMIs were compared with national data to calculate z scores. Increasing pregnancy glucose levels were associated with increased offspring BMI z scores at 7 years of age; a 1-mmol/L increase in glucose corresponded to an increase of 0.11 (standard deviation = 0.044) z-score units (P < 0.05). In nonobese women only, the mean z score over this age range increased with increasing glucose levels. The average BMI z score at 4.5 years of age increased by 0.12 (standard error, 0.059) units for each 1-mmol/L increase in glucose (P = 0.04). In obese women only, increasing glucose was associated with increases in BMI z score over time (P = 0.07). Whether interventions to reduce glucose values in women free of disease could mitigate childhood obesity remains unknown. PMID:23504745

Ehrlich, Samantha F; Rosas, Lisa G; Ferrara, Assiamira; King, Janet C; Abrams, Barbara; Harley, Kim G; Hedderson, Monique M; Eskenazi, Brenda

2013-03-15

214

Alteration of endothelial function markers in women with gestational diabetes and their fetuses  

PubMed Central

Objective We tested the hypothesis that women with gestational diabetes mellitus (GDM) and their fetuses would demonstrate alterations in markers of endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and endothelial dysfunction and these changes would correlate with the levels of hyperglycemia through a pilot observational case-control study of women with GDM and their fetuses. Methods Levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), C-reactive protein (CRP), nitric oxide (NO), eNOS, p22-phox, and SOD gene expression, and endothelial progenitor cells (EPC) counts in both maternal and cord blood were measured at the time of delivery in women with and without GDM. Results We demonstrated the presence of decreased maternal circulating EPC counts, increased soluble adhesion molecules in maternal blood, decreased SOD expression in both maternal and cord blood and increased eNOS expression in both maternal and cord blood in women with GDM. Conclusions These data suggest that the molecular mechanisms behind oxidative stress in women with GDM and their fetuses appear similar to those hypothesized for non-pregnant adults with type 2 diabetes mellitus (DM).

Mordwinkin, Nicholas M.; Ouzounian, Joseph G.; Yedigarova, Larisa; Montoro, Martin N.; Louie, Stan G.; Rodgers, Kathleen E.

2013-01-01

215

L-Methionine Placental Uptake: Characterization and Modulation in Gestational Diabetes Mellitus.  

PubMed

Our aim was to investigate the influence of gestational diabetes mellitus (GDM) and GDM-associated conditions upon the placental uptake of (14)C-l-methionine ((14)C-l-Met). The (14)C-l-Met uptake by human trophoblasts (TBs) obtained from normal pregnancies (normal trophoblast [NTB] cells) is mainly system l-type amino acid transporter 1 (LAT1 [L])-mediated, although a small contribution of system y(+)LAT2 is also present. Comparison of (14)C-l-Met uptake by NTB and by human TBs obtained from GDM pregnancies (diabetic trophoblast [DTB] cells) reveals similar kinetics, but a contribution of systems A, LAT2, and b(0+) and a greater contribution of system y(+)LAT1 appears to exist in DTB cells. Short-term exposure to insulin and long-term exposure to high glucose, tumor necrosis factor-?, and leptin decrease (14)C-l-Met uptake in a human TB (Bewo) cell line. The effect of leptin was dependent upon phosphoinositide 3-kinase, extracellular-signal-regulated kinase 1/2 (ERK/MEK 1/2), and p38 mitogen-activated protein kinase. In conclusion, GDM does not quantitatively alter (14)C-l-Met placental uptake, although it changes the nature of transporters involved in that process. PMID:23653387

Araújo, João R; Correia-Branco, Ana; Ramalho, Carla; Gonçalves, Pedro; Pinho, Maria J; Keating, Elisa; Martel, Fátima

2013-05-01

216

Lipid metabolism alterations in patients with gestational diabetes mellitus associated fetal macrosomia.  

PubMed

Fetal macrosomia is commonly associated with gestational diabetes mellitus (GDM) which may lead to various complications. It has been suggested that some other metabolites apart from maternal hyperglycemia are responsible for the genesis of macrosomia. Lipid metabolism changes in GDM patients having macrosomic fetuses were studied. A lipid tolerance test (10% Lipovenous solution) was performed in 14 GDM. Pre- and post-infusion plasma lipid levels and their elimination rates were measured and compared to the ones of 8 non diabetic control pregnant women. HbA1c, basal glucose and triglyceride levels were found to be higher in GDM group and significantly higher levels of triglycerides persisted throughout the infusion. FFA, glycerol and phospholipid levels increased following infusion in both groups without significant differences. Glucose, C-peptide and insulin levels remained unchanged after the infusion. Increased basal triglycerides with slowed triglyceride metabolism may be responsible for the fetal macrosomia in mild GDM patients whose fasting blood glucose are below 105 mg/dl. A better metabolic control that provides plasma lipid regulation as well as glucose control may forestall the occurrence of fetal macrosomia. PMID:9542273

Ersanli, Z O; Damci, T; Sen, C; Hacibekiroglu, M; Görpe, U; Ozyazar, M; Ilkova, H; Bagriacik, N

1997-01-01

217

Insulin Secretion and Incretin Hormone Concentration in Women with Previous Gestational Diabetes Mellitus  

PubMed Central

Background We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM). Methods A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concentrations were measured, and their anthropometric and biochemical markers were also measured. Results Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a significantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was elevated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concentration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT. Conclusion GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.

Yu, Sung Hoon; Cho, Bongjun; Lee, Yejin; Kim, Eunhye; Choi, Sung Hee; Lim, Soo; Yi, Ka Hee; Park, Young Joo; Park, Kyong Soo

2011-01-01

218

Social Support Modifies the Association Between Household Food Insecurity and Depression Among Latinos with Uncontrolled Type 2 Diabetes  

PubMed Central

Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ?21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.

Wagner, Julie; Damio, Grace; Segura-Perez, Sofia; Chhabra, Jyoti; Vega-Lopez, Sonia; Perez-Escamilla, Rafael

2011-01-01

219

Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus.  

PubMed

Women with gestational diabetes mellitus (GDM) have a high risk of developing postpartum type 2 diabetes. Strategies to prevent postpartum type 2 diabetes are important to reduce the epidemic of diabetes and its societal impact. Breastfeeding was reported to improve early postpartum glucose tolerance and reduce the subsequent risk of type 2 diabetes. To investigate whether breastfeeding influences short- and long-term postpartum diabetes outcomes, women with GDM (n = 304) participating in the prospective German GDM study were followed from delivery for up to 19 years postpartum for diabetes development. All participants were recruited between 1989 and 1999. Postpartum diabetes developed in 147 women and was dependent on the treatment received during pregnancy (insulin vs. diet), BMI, and presence/absence of islet autoantibodies. Among islet autoantibody-negative women, breastfeeding was associated with median time to diabetes of 12.3 years compared with 2.3 years in women who did not breastfeed. The lowest postpartum diabetes risk was observed in women who breastfed for >3 months. On the basis of these results, we recommend that breastfeeding should be encouraged among these women because it offers a safe and feasible low-cost intervention to reduce the risk of subsequent diabetes in this high-risk population. PMID:23069624

Ziegler, Anette-G; Wallner, Maike; Kaiser, Imme; Rossbauer, Michaela; Harsunen, Minna H; Lachmann, Lorenz; Maier, Jörg; Winkler, Christiane; Hummel, Sandra

2012-10-15

220

Optimal Glycemic Control, Pre-eclampsia, and Gestational Hypertension in Women With Type 1 Diabetes in the Diabetes and Pre-eclampsia Intervention Trial  

PubMed Central

OBJECTIVE To assess the relationship between glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes. RESEARCH DESIGN AND METHODS Pregnancy outcome (pre-eclampsia or gestational hypertension) was assessed prospectively in 749 women from the randomized controlled Diabetes and Pre-eclampsia Intervention Trial (DAPIT). HbA1c (A1C) values were available up to 6 months before pregnancy (n = 542), at the first antenatal visit (median 9 weeks) (n = 721), at 26 weeks’ gestation (n = 592), and at 34 weeks’ gestation (n = 519) and were categorized as optimal (<6.1%: referent), good (6.1–6.9%), moderate (7.0–7.9%), and poor (?8.0%) glycemic control, respectively. RESULTS Pre-eclampsia and gestational hypertension developed in 17 and 11% of pregnancies, respectively. Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia (P < 0.05, respectively). In early pregnancy, A1C ?8.0% was associated with a significantly increased risk of pre-eclampsia (odds ratio 3.68 [95% CI 1.17–11.6]) compared with optimal control. At 26 weeks’ gestation, A1C values ?6.1% (good: 2.09 [1.03–4.21]; moderate: 3.20 [1.47–7.00]; and poor: 3.81 [1.30–11.1]) and at 34 weeks’ gestation A1C values ?7.0% (moderate: 3.27 [1.31–8.20] and poor: 8.01 [2.04–31.5]) significantly increased the risk of pre-eclampsia compared with optimal control. The adjusted odds ratios for pre-eclampsia for each 1% decrement in A1C before pregnancy, at the first antenatal visit, at 26 weeks’ gestation, and at 34 weeks’ gestation were 0.88 (0.75–1.03), 0.75 (0.64–0.88), 0.57 (0.42–0.78), and 0.47 (0.31–0.70), respectively. Glycemic control was not significantly associated with gestational hypertension. CONCLUSIONS Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy. These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes.

Holmes, Valerie A.; Young, Ian S.; Patterson, Christopher C.; Pearson, Donald W.M.; Walker, James D.; Maresh, Michael J.A.; McCance, David R.

2011-01-01

221

Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus.  

PubMed

The relationship between late-onset gestational diabetes mellitus [GDM] and oxidative stress is not well known, and the importance of the oxidant/antioxidant equilibrium in the clinical evolution and its complications require elucidation. The aim of the study was to evaluate the relationships between maternal levels of markers of oxidative stress in women with late-onset GDM that, potentially, may have considerable clinical implications in the pathogenesis and/or the evolution of GDM. Pregnant women (n = 78; 53 with GDM, 25 controls), between the 24th and 29th week of gestation, were enrolled. Both groups were analysed for demographic data, perinatal and obstetrics outcomes together with the levels of the marker's oxidative stress and antioxidant status. Control versus patient results in the univariate analysis were the following: pre-gestational body mass index [BMI] 23.31 ± 4.2 vs. 27.13 ± 4.6 kg/m(2) (P = 0.001); weeks at delivery 39.2 ± 3.05 vs. 38.9 ± 1.8 (P = 0.09); Caesarean delivery 12.5 vs. 43% (P = 0.004); macrosomia 4 vs. 9.4% (P = 0.6); lipoperoxides [LPO] 2.06 ± 1.00 vs. 3.14 ± 1.55 ?mol/mg (P = 0.001); catalase 3.23 ± 1.41 vs. 2.52 ± 1.3 nmol/min/ml (P = 0.03); superoxide dismutase [SOD] 0.11 ± 0.04 vs. 0.08 ± 0.01 U/ml (P = 0.0003); glutathione peroxidase [GPX] 0.03 ± 0.006 vs. 0.025 ± 0.006 nmol/min/ml (P = 0.01); glutathione reductase [GSH] 0.004 ± 0.002 vs. 0.004 ± 0.004 nmol/min/ml (P = 0.9)]; and glutathione transferase [GST] 0.0025 ± 0.0012 vs. 0.0027 ± 0.00017 nmol/min/ml (P = 0.7). Multivariate analysis showed catalase might have a protective effect against GDM development and LPO seems to be a risk factor for the disease. These data suggest an increase in oxidative stress and a decrease in antioxidative defence in women with late-onset GDM and, as such, may have considerable clinical implications in the pathogenesis and/or the course of the pregnancy in these patients. PMID:21327985

López-Tinoco, Cristina; Roca, Mar; García-Valero, Amor; Murri, Mora; Tinahones, Francisco J; Segundo, Carmen; Bartha, José L; Aguilar-Diosdado, Manuel

2011-02-17

222

Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes  

PubMed Central

Background Women who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program. Methods We used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews. Results Of 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach. Conclusion Time constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM. Trial Registration ClinicalTrials.gov: NCT01102530

2011-01-01

223

Effect of insulin degludec versus sitagliptin in patients with type 2 diabetes uncontrolled on oral antidiabetic agents  

PubMed Central

Aim The efficacy and safety of insulin degludec (IDeg), a new basal insulin with an ultra-long duration of action, was compared to sitagliptin (Sita) in a 26-week, open-label trial. Methods Insulin-naïve subjects with type 2 diabetes [n = 458, age: 56 years, diabetes duration: 7.7 years, glycosylated haemoglobin (HbA1c):8.9% (74 mmol/mol)] were randomized (1:1) to once-daily IDeg or Sita (100 mg orally) as add-on to stable treatment with 1 or 2 oral antidiabetic drugs (OADs). Results Superiority of IDeg to Sita in improving HbA1c and fasting plasma glucose (FPG) was confirmed [estimated treatment difference (ETD) IDeg–Sita for HbA1c: ?0.43%-points [95% confidence interval (CI): ?0.61; ?0.24, p < 0.0001] and for FPG: ?2.17 mmol/l (95% CI: ?2.59; ?1.74, p < 0.0001)]. HbA1c < 7% (<53 mmol/mol) was achieved by 41% (IDeg) versus 28% (Sita) of patients, estimated odds ratio IDeg/Sita: 1.60 (95% CI: 1.04; 2.47, p = 0.034). There was no statistically significant difference in the rate of nocturnal confirmed hypoglycaemia between IDeg and Sita [0.52 vs. 0.30 episodes/patient-year, estimated rate ratio (ERR): IDeg/Sita: 1.93 (95% CI: 0.90; 4.10, p = 0.09)]. Rates of overall confirmed hypoglycaemia were higher with IDeg than with Sita [3.1 vs. 1.3 episodes/patient-year, ERR IDeg/Sita: 3.81 (95% CI: 2.40; 6.05, p < 0.0001)]. IDeg was associated with a greater change in body weight than Sita [ETD IDeg–Sita: 2.75 kg (95% CI: 1.97; 3.54, p < 0.0001)]. The overall rates of adverse events were low and similar for both groups. Conclusions In patients unable to achieve good glycaemic control on OAD(s), treatment intensification with IDeg offers an effective, well-tolerated alternative to the addition of a second or third OAD.

Philis-Tsimikas, A; Del Prato, S; Satman, I; Bhargava, A; Dharmalingam, M; Skj?th, T V; Rasmussen, S; Garber, A J

2013-01-01

224

Resolution of Uncontrolled Type 2 Diabetes after Laparoscopic Truncal Vagotomy, Subtotal Gastrectomy, and Roux-en-Y Gastrojejunostomy for a Patient with Intractable Gastric Ulcers  

PubMed Central

Background. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been shown to be an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. However, it is unclear just how effective the LRYGB procedure is on T2DM for patients with BMI less than 35?kg/m2. We report one obese patient with T2DM who did not meet the current NIH criteria for morbid obesity surgery. This patient underwent a laparoscopic truncal vagotomy, subtotal gastrectomy, and Roux-en-Y gastrojejunostomy for intractable gastric ulcers and subsequently had full resolution of her T2DM. Methods. A 48-year-old patient with a BMI of 34.6?kg/m2 underwent a laparoscopic truncal vagotomy, subtotal gastrectomy, and Roux-en-Y gastrojejunostomy for intractable gastric ulcers. The patient was seen 3 months preoperatively, followed for 24 months postoperatively, and evaluated for postoperative complications, weight loss, and improvement in comorbidities. Results. The patient had no postoperative surgical complications. Her BMI decreased from 34.6?kg/m2 to 22.3?kg/m2 by 24 months postoperatively. Significant improvements in her fasting blood glucose levels were seen 10 days postoperatively from a preoperative level of 147?mg/dl to 97?mg/dl. Conclusion. Patients with a BMI less than 35?kg/m2 and uncontrolled T2DM may benefit from a laparoscopic Roux-en-Y gastric bypass.

Tait, Laura F.; Ortega, Gezzer; Tran, Daniel D.; Fullum, Terrence M.

2012-01-01

225

Health system and societal barriers for gestational diabetes mellitus (GDM) services - lessons from World Diabetes Foundation supported GDM projects  

PubMed Central

Background Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Gestational Diabetes Mellitus (GDM) represents an underestimated and unrecognised impediment to optimal maternal health in LMIC; left untreated – it also has severe consequences for the offspring. A better understanding of the barriers hindering detection and treatment of GDM is needed. Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts. Methods Questionnaires were filled out by 10 WDF supported GDM project partners implementing projects in eight different LMIC. In addition, interviews were conducted with the project partners. The interviews were analysed using content analysis. Results Barriers to improving maternal health related to GDM nominated by project implementers included lack of trained health care providers - especially female doctors; high staff turnover; lack of standard protocols, consumables and equipment; financing of health services and treatment; lack of or poor referral systems, feedback mechanisms and follow-up systems; distance to health facility; perceptions of female body size and weight gain/loss in relation to pregnancy; practices related to pregnant women’s diet; societal negligence of women’s health; lack of decision-making power among women regarding their own health; stigmatisation; role of women in society and expectations that the pregnant woman move to her maternal home for delivery. Conclusions A number of barriers within the health system and society exist. Programmes need to consider and address these barriers in order to improve GDM care and thereby maternal health in LMIC.

2012-01-01

226

Meta-Analysis of the Relationship between Common Type 2 Diabetes Risk Gene Variants with Gestational Diabetes Mellitus  

PubMed Central

Background A number of case-control studies were conducted to investigate the association of common type 2 diabetes (T2D) risk gene polymorphisms with gestational diabetes mellitus (GDM). However, these studies have yielded contradictory results. We therefore performed a meta-analysis to derive a more precise estimation of the association between these polymorphisms and GDM, hence achieve a better understanding to the relationship between T2D and GDM. Methods PubMed, EMBASE, ISI web of science and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to examine the association between 9 polymorphisms from 8 genes and susceptibility to GDM. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Heterogeneity among articles and their publication bias were also tested. Results We identified 22 eligible studies including a total of 10,336 GDM cases and 17,445 controls. We found 8 genetic polymorphisms were significantly associated with GDM in a random-effects meta-analysis. These polymorphisms were in or near the following genes: TCF7L2 (rs7903146), MTNR1B (rs10830963), IGF2BP2 (rs4402960), KCNJ11 (rs5219), CDKAL1 (rs7754840), KCNQ1 (rs2237892 and rs2237895) and GCK (rs4607517); while no association was found for PPARG with GDM risk. Similar results were also observed under dominant genetic model for these polymorphisms. Conclusions This meta-analysis found 8 genetic variants associated with GDM. The relative contribution and relevance of the identified genes in the pathogenesis of GDM should be the focus of future studies.

Gao, Shujun

2012-01-01

227

Gestational Diabetes and Subsequent Growth Patterns of Offspring: The National Collaborative Perinatal Project  

PubMed Central

Our objective was to test the hypothesis that intrauterine exposure to gestational diabetes [GDM] predicts childhood growth independent of the effect on infant birthweight. We conducted a prospective analysis of 28,358 mother-infant pairs who enrolled in the National Collaborative Perinatal Project between 1959 and 1965. The offspring were followed until age 7. Four hundred and eighty-four mothers (1.7%) had GDM. The mean birthweight was 3.2 kg (range 1.1–5.6 kg). Maternal characteristics (age, education, race, family income, pre-pregnancy body mass index and pregnancy weight gain) and measures of childhood growth (birthweight, weight at ages 4, and 7) differed significantly by GDM status (all P < 0.05). As expected, compared to their non-diabetic counterparts, mothers with GDM gave birth to offspring that had higher weights at birth. The offspring of mothers with GDM were larger at age 7 as indicated by greater weight, BMI and BMI z-score compared to the offspring of mothers without GDM at that age (all P < 0.05). These differences at age 7 persisted even after adjustment for infant birthweight. Furthermore, the offspring of mothers with GDM had a 61% higher odds of being overweight at age 7 compared to the offspring of mothers without GDM after adjustment for maternal BMI, pregnancy weight gain, family income, race and birthweight [OR = 1.61 (95%CI:1.07, 1.28)]. Our results indicate that maternal GDM status is associated with offspring overweight status during childhood. This relationship is only partially mediated by effects on birthweight.

Nicholson, Wanda K.; Wang, Nae-Yuh; Brancati, Frederick L.

2013-01-01

228

Carotid Intimal-Medial Thickness Is Not Increased in Women with Previous Gestational Diabetes Mellitus  

PubMed Central

Background Gestational diabetes mellitus (GDM) is known to increase the risk of cardiovascular diseases. Measuring the carotid artery intimal-medial thickness (CIMT) is a non-invasive technique used to evaluate early atherosclerosis and to predict future cardiovascular diseases. We examined the association between CIMT and cardiovascular risk factors in young Korean women with previous GDM. Methods One hundred one women with previous GDM and 19 women who had normal pregnancies (NP) were recruited between 1999 and 2002. At one year postpartum, CIMT was measured using high-resolution B-mode ultrasonography, and oral glucose tolerance tests were performed. Fasting glucose, glycated hemoglobin A1c (HbA1c), insulin levels and lipid profiles were also measured. CIMTs in the GDM and NP groups were compared, and the associations between CIMT and cardiovascular risk factors were analyzed in the GDM group. Results CIMT results of the GDM group were not significantly different from those of the NP group (GDM, 0.435±0.054 mm; NP, 0.460±0.046 mm; P=0.069). In the GDM group, a higher HbA1c was associated with an increase in CIMT after age adjustment (P=0.011). CIMT results in the group with HbA1c >6.0% were higher than those of the normal HbA1c (HbA1c ?6.0%) (P=0.010). Nine of the patients who are type 2 diabetes mellitus converters within one year postpartum but showed no significant difference in CIMT results compared to NP group. Conclusion Higher HbA1c is associated with an increase in CIMT in women with previous GDM. However, CIMT at one year postpartum was not increased in these women compared to that in NP women.

Ku, Yun Hyi; Lim, Soo; Cho, Young Min; Park, Young Joo; Park, Kyong Soo; Kim, Seong Yeon; Jang, Hak Chul

2011-01-01

229

Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus123  

PubMed Central

Background: Previous studies observed inverse associations of adherence to the alternate Mediterranean (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary patterns with risk of type 2 diabetes; however, their associations with gestational diabetes mellitus (GDM) risk are unknown. Objective: This study aimed to assess usual prepregnancy adherence to well-known dietary patterns and GDM risk. Design: Our study included 21,376 singleton live births reported from 15,254 participants of the Nurses’ Health Study II cohort between 1991 and 2001. Pregnancies were free of prepregnancy chronic disease or previous GDM. Prepregnancy dietary pattern adherence scores were computed based on participants’ usual intake of the patterns’ components, assessed with a validated food-frequency questionnaire. Multivariable logistic regressions with generalized estimating equations were used to estimate the RRs and 95% CIs. Results: Incident first-time GDM was reported in 872 pregnancies. All 3 scores were inversely associated with GDM risk after adjustment for several covariables. In a comparison of the multivariable risk of GDM in participants in the fourth and first quartiles of dietary pattern adherence scores, aMED was associated with a 24% lower risk (RR: 0.76; 95% CI: 0.60, 0.95; P-trend = 0.004), DASH with a 34% lower risk (RR: 0.66; 95% CI: 0.53, 0.82; P-trend = 0.0005), and aHEI with a 46% lower risk (RR: 0.54; 95% CI: 0.43, 0.68; P-trend < 0.0001). Conclusion: Prepregnancy adherence to healthful dietary patterns is significantly associated with a lower risk of GDM.

Tobias, Deirdre K; Zhang, Cuilin; Chavarro, Jorge; Bowers, Katherine; Rich-Edwards, Janet; Rosner, Bernard; Mozaffarian, Dariush; Hu, Frank B

2012-01-01

230

2D-DIGE to identify proteins associated with gestational diabetes in omental adipose tissue.  

PubMed

Gestational diabetes mellitus (GDM) is a significant risk factor for the type 2 diabetes epidemic in many populations. Maternal adipose tissue plays a central role in the pathophysiology of GDM. Thus, the aim of this study was to determine the effect of GDM on the proteome of adipose tissue. Omental adipose tissue was obtained at the time of term Caesarean section from women with normal glucose tolerance (NGT) or GDM. 2D-difference gel electrophoresis (DIGE), followed by mass spectrometry, was used to identify protein spots (n = 6 patients per group). Western blotting was used for confirmation of six of the spot differences (n = 6 patients per group). We found 14 proteins that were differentially expressed between NGT and GDM adipose tissue (? 1.4-fold, P < 0.05). GDM was associated with an up-regulation of four proteins: collagen alpha-2(VI) chain (CO6A2 (COL6A2)), fibrinogen beta chain (FIBB (FGB)), lumican (LUM) and S100A9. On the other hand, a total of ten proteins were found to be down-regulated in adipose tissue from GDM women. These were alpha-1-antitrypsin (AIAT (SERPINA 1)), annexin A5 (ANXA5), fatty acid-binding protein, adipocyte (FABP4), glutathione S-transferase P (GSTP (GSTP1)), heat-shock protein beta-1 (HSP27 (HSPB1)), lactate dehydrogenase B chain (LDHB), perilipin-1 (PLIN1), peroxiredoxin-6 (PRX6 (PRDX6)), selenium-binding protein 1 (SBP1) and vinculin (VINC (VCL)). In conclusion, proteomic analysis of omental fat reveals differential expression of several proteins in GDM patients and NGT pregnant women. This study revealed differences in expression of proteins that are involved in inflammation, lipid and glucose metabolism and oxidative stress and added further evidence to support the role of visceral adiposity in the pathogenesis of GDM. PMID:23709000

Oliva, Karen; Barker, Gillian; Rice, Gregory E; Bailey, Mark J; Lappas, Martha

2013-07-01

231

The role of continuing metformin therapy during pregnancy in the reduction of gestational diabetes and improving pregnancy outcomes in women with polycystic ovary syndrome  

Microsoft Academic Search

ObjectivesTo evaluate the value of continuing metformin therapy in women with PCOS throughout pregnancy and its role in reducing the development of gestational diabetes and improving pregnancy outcome by reducing spontaneous miscarriage rate.

Azza A. Abd El Hameed; Hala E. Shreif; Hala E. Mowafy

2011-01-01

232

Analysis of phosphatidylinositol 3-kinase activation in the adipose tissue of gestational diabetes mellitus patients and insulin resistance  

Microsoft Academic Search

Summary  The P85 regulatory subunit protein and gene expression and P110 catalylic subunit activity of phosphatidylinositol 3-kinase\\u000a (PI-3K) were investigated in adipose tissue of patients with gestational diabetes mellitus (GDM) in order to explore the molecular\\u000a mechanisms of insulin resistance (IR) of GDM. Samples from patients with GDM (n=50), and controls (n=50) were collected. Fasting insulin (FIN) was determined by radioimmunoassay.

Yongli Chu; Wenjuan Liu; Qing Cui; Guijiao Feng; Yan Wang; Xueqiang Jiang

2010-01-01

233

The impact of new national guidelines on screening for gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) has important maternal and fetal implications. In 2010, the Health Service Executive published guidelines on GDM. We examined the impact of the new guidelines in a large maternity unit. In January 2011, the hospital replaced the 100 g Oral Glucose Tolerance Test (OGTT) with the new 75 g OGTT. We compared the first 6 months of 2011 with the first 6 months of 2010. The new guidelines were associated with a 22% increase in women screened from 1375 in 2010 to 1679 in 2011 (p < 0.001). Of the women screened, the number diagnosed with GDM increased from 10.1% (n=139) to 13.2% (n=221) (p<0.001).The combination of increased screening and a more sensitive OGTT resulted in the number of women diagnosed with GDM increasing 59% from 139 to 221 (p = 0.02).This large increase has important resource implications but, if clinical outcomes are improved, there should be a decrease in long-term costs. PMID:23472391

Ali, F M; Farah, N; O'Dwyer, V; O'Connor, C; Kennelly, M M; Turner, M J

2013-02-01

234

Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index  

PubMed Central

Background The aim was to evaluate the metabolic profile in conjunction with vascular function using the ambulatory arterial stiffness index (AASI) in women with uncomplicated pregnancies and in women with gestational diabetes mellitus (GDM). Methods Plasma glucose, lipids, HOMA –IR (homeostasis model assessment of insulin resistance) and AASI, as obtained from 24-hour ambulatory blood pressure monitoring in third trimester pregnancy and at three months postpartum, were measured in three groups of women: controls (N = 32), women with GDM on diet (N = 42) and women with GDM requiring insulin treatment (N = 10). Results Women with GDM had poorer glycemic control and higher HOMA-IR during and after pregnancy and their total and LDL (low density lipoprotein) cholesterol levels were significantly higher after pregnancy than in the controls. After delivery, there was an improvement in AASI from 0.26 ± 0.10 to 0.17 ± 0.09 (P = 0.002) in women with GDM on diet, but not in women with GDM receiving insulin whose AASI tended to worsen after delivery from 0.30 ± 0.23 to 0.33 ± 0.09 (NS), then being significantly higher than in the other groups (P = 0.001-0.047). Conclusions Women with GDM had more unfavorable lipid profile and higher blood glucose values at three months after delivery, the metabolic profile being worst in women requiring insulin. Interestingly, the metabolic disturbances at three months postpartum were accompanied by a tendency towards arterial stiffness to increase in women requiring insulin.

2013-01-01

235

Maternal and cord blood apelin, resistin and visfatin levels in gestational diabetes mellitus.  

PubMed

Aim: The aim of this paper was to investigate maternal and cord blood apelin, resistin and visfatin concentrations in pregnant women with and without gestational diabetes mellitus (GDM). Methods: This case-control study was conducted on 24 women with GDM and 21 women without GDM. Maternal plasma and cord blood apelin, resistin and visfatin levels were measured with ELISA. Results: The cord blood apelin levels were significantly lower in women with GDM than control subjects (111.23±31.53 vs.. 257.48±133.97 pg/mL, P=0.002). However, the decrease of maternal apelin levels in GDM group was not statistically significant (140.76±48.38 vs. 163.53±91.12 pg/mL, P=0.602). Women with GDM had lower maternal and cord blood visfatin concentrations and higher resistin concentrations than control group. Maternal resistin concentrations were significantly correlated with HOMA-IR (r=0.745, P=0.005). The apelin and visfatin levels did not correlate with HbA1c, BMI, HOMA-IR, glucose and birth weight. Conclusion: GDM is associated with lower cord blood apelin levels than control subjects. GDM appears to influence fetoplacental apelin metabolism. Apelin may not be directly involved in the regulation of maternal insulin sensitivity. Our results indicate that there is an increase in resistin concentrations and a decrease in visfatin concentrations in maternal serum and cord blood serum with GDM. PMID:24101110

Oncul, M; Tuten, A; Erman, H; Gelisgen, R; Benian, A; Uzun, H

2013-10-01

236

Assessment of the number and function of macrophages in the placenta of gestational diabetes mellitus patients.  

PubMed

In order to assess the number and function of macrophages in the placenta of pregnancy complicated with gestational diabetes mellitus (GDM) as well as those of normal pregnancies, placenta samples were collected from 15 GDM patients (GDM group) and 10 normal pregnant women (control group). The expression levels of macrophage markers (CD68/CD14) and inflammatory cytokines (IL-6/TNF-?) in placenta were detected using immunohistochemistry and PCR. The results showed that the number of CD68+ or CD14+ cells in the GMD group was remarkably higher than that in the control group (P<0.05), indicating that the number of macrophages in the GDM group was significantly greater than that in the control group. The mRNA expression levels of CD68+, IL-6 and TNF-? were higher in the GMD group than in the control group. In conclusion, more macrophages accumulate in placenta of pregnancy complicated with GDM, and the expression levels of pro-inflammation factors are also increased in GDM pregnancies, suggesting that macrophages and inflammatory mediators (IL-6 and TNF-?) may play an important role in GDM. PMID:24142727

Yu, Jun; Zhou, Yong; Gui, Juan; Li, Ai-Zhen; Su, Xiao-Ling; Feng, Ling

2013-10-20

237

Comparison of obese and non-obese patients with gestational diabetes.  

PubMed

The aim of this study was to assess the effect of obesity on the outcome of gestational diabetes (GD). The age of the subject (31 +/- 5 years) and duration of pregnancy (29 +/- 5 weeks) were similar at the time of diagnosis for the 19 obese (34 +/- 6 kg/m2) and 19 non-obese (23.0 +/- 2.1 kg/m2) subjects. Before treatment, the area under the curve of the glucose tolerance test and the mean capillary blood glucose levels were similar in both groups; however, the baseline blood glucose levels of the obese patients (6.0 +/- 0.8 mmol/l) were higher than those of the non-obese patients (5.3 +/- 0.8 mmol/l; P < 0.01). During pregnancy, the total weight gain of the obese patients was less (10.6 +/- 5.0 vs. 15.2 +/- 4.7 kg, P < 0.006). Fifteen of the obese patients required treatment with insulin, while only six of the non-obese women required insulin (P < 0.005). During insulin therapy, the mean capillary blood glucose, glycosylated haemoglobin and fructosamine levels were similar in both groups. In conclusion, our data suggest that GD in obese patients is characterized by lower weight gain and higher baseline glucose with the result that insulin therapy is more frequently instituted. PMID:8242130

Comtois, R; Séguin, M C; Aris-Jilwan, N; Couturier, M; Beauregard, H

1993-10-01

238

Perinatal outcomes of Southeast Asians with pregnancies complicated by gestational diabetes mellitus or preeclampsia.  

PubMed

To examine risks for adverse perinatal outcomes among Southeast Asian women with pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia. Perinatal outcomes of singleton births of Cambodian (3,489), Laotian (2,038), Vietnamese (11,605), Japanese (3,083) and non-Hispanic White women (33,088) were analyzed using Washington state linked birth certificate and hospitalization discharge records (1993-2006). Both Cambodian (aOR = 1.68) and Laotian (aOR = 1.71) women with GDM had increased odds of macrosomia when compared with Japanese women with GDM. Southeast Asian women with GDM had reduced odds of macrosomia when compared with White women. Southeast Asian women with preeclampsia had increased odds for preterm delivery when compared with Japanese and White women with preeclampsia. Research is needed to understand why Southeast Asian women with GDM are more likely to have better perinatal outcomes when compared with White women. Vigilant monitoring and culturally sensitive care for Southeast Asian women with preeclampsia is needed. PMID:22002706

Cripe, Swee May; O'Brien, William; Gelaye, Bizu; Williams, Michelle A

2012-10-01

239

Ethnic differences in the association between gestational diabetes and pregnancy outcome.  

PubMed

The purpose of the study was to examine ethnic variation in the impact of Gestational Diabetes Mellitus (GDM) on birth outcome. The authors examined the association between GDM and pregnancy-induced hypertension, macrosomia, primary Cesarean delivery, and preterm birth, using New York City Birth Certificate data from 2001-2006. Logistic regression was used to evaluate the crude and adjusted odds ratios of GDM with each adverse perinatal event, stratified by ethnicity. GDM was associated with increased risk of adverse perinatal events among all ethnic groups, with modest variation by ethnicity. Across ethnic groups, adjusted odds ratios comparing women with and without GDM ranged from 1.4-2.9 for pregnancy-induced hypertension, 1.0-2.2 for macrosomia, 1.1-1.8 for primary Cesarean delivery, and 1.3-1.8 for preterm birth. Overall, Caribbean, Sub-Saharan African, and African American women tended to show a larger relative impact of GDM, while North African, South Central Asian, and Chinese women showed a comparatively smaller impact of GDM. Although some ethnic variation was seen, differences in effect size were not large enough to support ethnic-specific thresholds for GDM diagnosis and treatment. PMID:21365298

Mocarski, M; Savitz, D A

2012-02-01

240

A variant in the transcription factor 7-like 2 ( TCF7L2 ) gene is associated with an increased risk of gestational diabetes mellitus  

Microsoft Academic Search

Aims\\/hypothesis  Genetic and epidemiological studies suggest an association between gestational diabetes mellitus and type 2 diabetes. Both\\u000a are polygenic multifactorial disorders characterised by beta cell dysfunction and insulin resistance. Our aim was to investigate\\u000a whether common genetic variants that have previously been associated with type 2 diabetes or related phenotypes would also\\u000a confer risk for gestational diabetes mellitus.\\u000a \\u000a \\u000a \\u000a Materials and methods  In

N. Shaat; Å. Lernmark; E. Karlsson; S. Ivarsson; H. Parikh; K. Berntorp; L. Groop

2007-01-01

241

Inflammation and impaired endothelium-dependant vasodilatation in non obese women with gestational diabetes mellitus: preliminary results  

PubMed Central

Background To evaluate whether abnormal endothelial function, a common finding in gestational diabetes mellitus (GDM) pregnancies, can be explained by inflammatory cytokines. Methods Forearm skin blood flow (FSBF), into response to acetylcholine (Ach) (endothelium-dependent vasodilatation), were measured in 24 pregnant control subjects and 28 gestational diabetes mellitus (GDM) women, in the third trimester of gestation. A fasting glycemic and lipidic panel was obtained, and inflammatory cytokines (TNF-? and IL-6) and adiponectin were also determined. Results FSBF is significantly reduced in GDM group compared with control subjects (344.59 ± 57.791 vs.176.38 ± 108.52, P < 0.05). Among all subjects, FSBF showed a strong negative correlation with TNF-? and IL-6 (r = ?0.426, P < 0.0001 and r = ?0.564, P < 0.0001, respectively) and positive correlation with adiponectin (r = 0.468, P < 0.0001). Conclusions Endothelial function, an early marker of macrovascular disease, is present in non-obese pregnancies complicated by GDM. This alteration seems to be directly related to inflammatory status, which may represent a patho-physiological link between GDM and type 2 diabetes and, later on, metabolic syndrome.

2013-01-01

242

Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia  

Microsoft Academic Search

Aims\\/hypothesis  Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the\\u000a diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than\\u000a those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which

A. Ferrara; N. S. Weiss; M. M. Hedderson; C. P. Quesenberry Jr; J. V. Selby; I. J. Ergas; T Peng; G. J. Escobar; D. J. Pettitt; D. A. Sacks

2007-01-01

243

Cord blood chemerin: differential effects of gestational diabetes mellitus and maternal obesity.  

PubMed

OBJECTIVE: Chemerin is a novel adipokine implicated in inflammation and obesity. We hypothesized that foetal chemerin would be elevated in gestational diabetes mellitus (GDM) and correlate with foetal and maternal adiposity. DESIGN: Observational, longitudinal study. SUBJECTS AND MEASUREMENTS: Foetal chemerin was measured separately in arterial and venous cord blood of 30 infants born to mothers with (n = 15) and without GDM (n = 15), in their mothers in early third trimester and at delivery and in amniotic fluid (week 32) of women with GDM. Expression of chemerin and its receptor in human foetal tissues commercially available and in placental cells was measured by quantitative PCR. Associations between foetal and maternal anthropometric and metabolic variables were assessed in multivariate regression models. RESULTS: In GDM, foetal arterial but not venous cord blood chemerin levels were elevated by about 60% (P < 0·05). Venous cord blood chemerin was higher in infants of obese women (P < 0·01). In multivariate analyses, neither amniotic fluid nor cord blood chemerin levels correlated with birth weight or ponderal index. Both arterial and venous chemerin levels were related to maternal chemerin at birth, and arterial chemerin was associated with GDM status in addition. Maternal levels were unaltered in GDM, but higher in maternal obesity. Foetal liver produces fourfold more chemerin mRNA than other foetal tissues, whereas its receptor prevails in spleen. CONCLUSIONS: Based on multivariate analyses, foetal growth appears unrelated to foetal chemerin. Maternal obesity and GDM have differential effects on foetal chemerin levels. Site of major production (liver) and action (spleen) differ in human foetal tissues. PMID:23286837

van Poppel, Mireille N M; Zeck, Willibald; Ulrich, Daniela; Schest, Eva-Christina; Hirschmugl, Birgit; Lang, Uwe; Wadsack, Christian; Desoye, Gernot

2013-01-01

244

A Study of Snack Consumption, Night-Eating Habits, and Nutrient Intake in Gestational Diabetes Mellitus  

PubMed Central

This study was performed to identify dietary behavior such as snack consumption, night-eating and nutrients intake associated with gestational diabetes mellitus (GDM). The study was conducted on 219 normal glucose tolerance (NGT) subjects and 44 GDM subjects by using a questionnaire including dietary behavior, food frequency and 3-day food record. The mean age, OGTT, and delivery weight of GDM subjects were statistically higher than those in NGT. A larger proportion of NGT subjects consumed black coffee (49.8%) while the majority of GDM subjects (61.4%) drank mixed coffee with sugar and cream. Dairy products were the most frequently consumed snack item in NGT subjects (40.7%), while fruits were most frequently consumed food item in GDM subjects (34.4%). Many of NGT subjects (49.8%) answered that they hardly took night-eating snacks whereas most of GDM subjects (61.4%) took night-eating snacks more than once a week. For change of taste preference, the proportion of NGT subjects who showed less preference for salty taste (33.3%) or greasy taste (16.9%) was higher than that of GDM subjects (11.4%). Nutrient intakes of energy, fat, cholesterol, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), carbohydrate, vitamin B1, vitamin B2, vitamin C, and vitamin E in GDM group were significantly higher than those in NGT group. Nutrient densities of SFA and vitamin C in GDM group were higher and nutrient density of calcium was lower than those in NGT group. Taken together, it is recommended to reduce night-eating snack and choose less salty and fatty foods, black-coffee rather than coffee with cream and sugar, and more dairy products to prevent GDM.

Park, Hee-jin; Lee, JinJu; Kim, Ji-Myung; Lee, Hyun Ah

2013-01-01

245

Materno-fetal transfer of docosahexaenoic acid is impaired by gestational diabetes mellitus.  

PubMed

Better knowledge on the disturbed mechanisms implicated in materno-fetal long-chain polyunsaturated fatty acid (LC-PUFA) transfer in pregnancies with gestational diabetes mellitus (GDM) may have potentially high implications for later on in effective LC-PUFA supplementation. We studied in vivo placental transfer of fatty acids (FA) using stable isotope tracers administrated to 11 control and 9 GDM pregnant women (6 treated with insulin). Subjects received orally [(13)C]palmitic, [(13)C]oleic and [(13)C]linoleic acids, and [(13)C]docosahexaenoic acid ((13)C-DHA) 12 h before elective caesarean section. Maternal blood samples were collected at -12, -3, -2, and -1 h, delivery, and +1 h. Placental tissue and venous cord blood were also collected. FA were quantified by gas chromatography (GC) and (13)C enrichments by GC-isotope ratio mass spectrometry. [(13)C]FA concentration was higher in total lipids of maternal plasma in GDM vs. controls, except for [(13)C]DHA. Moreover, [(13)C]DHA showed lower placenta/maternal plasma ratio in GDM vs. controls and significantly lower cord/maternal plasma ratio. For the other studied FA, ratios were not different between GDM and controls. Disturbed [(13)C]DHA placental uptake occurs in both GDM treated with diet or insulin, whereas the last ones also have lower [(13)C]DHA in venous cord. The tracer study pointed toward impaired placental DHA uptake as critical step, whereas the transfer of the rest of [(13)C]FA was less affected. GDM under insulin treatment could also have higher fetal fat storage, contributing to reduce [(13)C]DHA in venous cord. DHA transfer to the fetus was reduced in GDM pregnancies compared with controls, which might affect the programming of neurodevelopment in their neonates. PMID:23921142

Pagán, Ana; Prieto-Sánchez, María T; Blanco-Carnero, José E; Gil-Sánchez, Alfonso; Parrilla, Juan J; Demmelmair, Hans; Koletzko, Berthold; Larqué, Elvira

2013-08-06

246

Human Breath Gas Analysis in the Screening of Gestational Diabetes Mellitus  

PubMed Central

Abstract Background We present a pilot study on the feasibility of the application and advantages of online, noninvasive breath gas analysis (BGA) by proton transfer reaction quadrupole mass spectrometry for the screening of gestational diabetes mellitus (GDM) in 52 pregnant women by means of an oral glucose tolerance test (OGTT). Subjects and Methods We collected and identified samples of end-tidal breath gas from patients during OGTT. Time evolution parameters of challenge-responsive volatile organic compounds (VOCs) in human breath gas were estimated. Multivariate analysis of variance and permutation analysis were used to assess feasibility of BGA as a diagnostic tool for GDM. Results Standard OGTT diagnosis identified pregnant women as having GDM (n=8), impaired glucose tolerance (n=12), and normal glucose tolerance (n=32); a part of this latter group was further subdivided into a “marginal” group (n=9) because of a marginal high 1-h or 2-h OGTT value. We observed that OGTT diagnosis (four metabolic groups) could be mapped into breath gas data. The time evolution of oxidation products of glucose and lipids, acetone metabolites, and thiols in breath gas after a glucose challenge was correlated with GDM diagnosis (P=0.035). Furthermore, basal (fasting) values of dimethyl sulfide and values of methanol in breath gas were inversely correlated with phenotype characteristics such as homeostasis model assessment of insulin resistance index (R=?0.538; P=0.0002, Pcorrected=0.0034) and pregestational body mass index (R=?0.433; P=0.0013, Pcorrected=0.022). Conclusions Noninvasive BGA in challenge response studies was successfully applied to GDM diagnosis and offered an insight into metabolic pathways involved. We propose a new approach to the identification of diagnosis thresholds for GDM screening.

Halbritter, Susanne; Fedrigo, Mattia; Hollriegl, Vera; Szymczak, Wilfried; Maier, Joerg M.; Hummel, Michael

2012-01-01

247

Effect of Treatment of Gestational Diabetes Mellitus on Obesity in the Next Generation  

PubMed Central

OBJECTIVE Gestational diabetes mellitus (GDM) may cause obesity in the offspring. The objective was to assess the effect of treatment for mild GDM on the BMI of 4- to 5-year-old children. RESEARCH DESIGN AND METHODS Participants were 199 mothers who participated in a randomized controlled trial of the treatment of mild GDM during pregnancy and their children. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance program in the state of South Australia. The main outcome measure was age- and sex-specific BMI Z score based on standards of the International Obesity Task Force. RESULTS At birth, prevalence of macrosomia (birth weight ?4,000 g) was 5.3% among the 94 children whose mothers were in the intervention group, and 21.9% among the 105 children in the routine care control group. At 4- to 5-years-old, mean (SD) BMI Z score was 0.49 (1.20) in intervention children and 0.41 (1.40) among controls. The difference between treatment groups was 0.08 (95% CI ?0.29 to 0.44), an estimate minimally changed by adjustment for maternal race, parity, age, and socio-economic index (0.08 [?0.29 to 0.45]). Evaluating BMI ?85th percentile rather than continuous BMI Z score gave similarly null results. CONCLUSIONS Although treatment of GDM substantially reduced macrosomia at birth, it did not result in a change in BMI at age 4- to 5-years-old.

Gillman, Matthew W.; Oakey, Helena; Baghurst, Peter A.; Volkmer, Robert E.; Robinson, Jeffrey S.; Crowther, Caroline A.

2010-01-01

248

Association of metabolic syndrome with inflammatory mediators in women with previous gestational diabetes mellitus  

PubMed Central

Background An increased risk of metabolic syndrome (MS) has been observed among women with previous gestational diabetes mellitus (pGDM). Increased inflammatory markers such as C-reactive protein (CRP) and interleukin 6 (IL-6) usually accompany. We performed this survey to examine the relationship between pGDM and MS, CRP and IL-6. Methods 77 women with pGDM and 67 randomly sampled women free from GDM participated in this study, 2–3 years after index pregnancy. Laboratory and anthropometric measurements were performed. MS was defined according to ATP III criteria. Statistical analyses were conducted using SPSS 18. Results CRP were different between groups with and without pGDM [2.69 (2.86 mg/dl and 1.56 (1.39) mg/dl, respectively; p < 0.01]. The presence of each MS component by itself was associated with significantly higher CRP Levels, except for fasting blood glucose. In linear regression models, CRP and IL-6 were significantly associated with BMI (? =0. 25, 0.23; p < 0.01), waist circumference (?=0. 27, 0.05; p < 0.01) and HOMA-IR (?=0. 39, 0.39; p < 0.01). After adjustment for age and BMI the occurrence of pGDM in the group with both high CRP and MS was significantly associated with CRP level (OR= 5.11; CI=1.59-16.43; p < 0.01). Conclusion Since CRP and Il-6 were higher in women with both pGDM and MS it appears that the presence of pGDM with MS components have a synergistic effect on the elevation of serum levels of inflammatory markers which can be partly as a result of visceral obesity. Further long-term studies are necessary to confirm the relationship between CRP, IL-6 and MS in women with pGDM.

2013-01-01

249

International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis.  

PubMed

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in countries of resettlement have a greater risk of gestational diabetes mellitus (GDM) than women in receiving countries. A systematic review of the literature from Medline, Embase, PsychInfo and CINAHL from 1990 to 2009 included studies of migrant women and GDM. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not the country of resettlement. Studies were assessed for quality, analysed descriptively and meta-analysed. Twenty-four reports (representing >120,000 migrants) met our inclusion criteria. Migrants were described primarily by geographic origin; other relevant aspects (e.g. time in country, language fluency) were rarely studied. Migrants' results for GDM were worse than those for receiving-country women in 79% of all studies. Meta-analyses showed that, compared with receiving-country women, Caribbean, African, European and Northern European women were at greater risk of GDM, while North Africans and North Americans had risks similar to receiving-country women. Although results of the 31 comparisons of Asians, East Africans or non-Australian Oceanians were too heterogeneous to provide a single GDM risk estimate for migrant women, only one comparison was below the receiving-country comparison group, all others presented a higher risk estimate. The majority of women migrants to resettlement countries are at greater risk for GDM than women resident in receiving countries. Research using clear, specific migrant definitions, adjusting for relevant risk factors and including other aspects of migration experiences is needed to confirm and understand these findings. PMID:21980947

Gagnon, Anita J; McDermott, Sarah; Rigol-Chachamovich, Juliana; Bandyopadhyay, Mridula; Stray-Pedersen, Babill; Stewart, Donna

2011-09-14

250

High Glucose Alters Proteoglycan Expression and the Glycosaminoglycan Composition in Placentas of Women with Gestational Diabetes Mellitus and in Cultured Trophoblasts  

Microsoft Academic Search

Impaired glucose metabolism with diabetes may alter the expressions of proteoglycans (PGs), which may impair the biological functions of placenta. In this study, we investigated the expression of PGs and their conjugated glycosaminoglycan (GAG) composition in the placentas of mothers with gestational diabetes mellitus (GDM) and trophoblasts cultured in a high-glucose condition. The PGs by guanidine\\/HCl extraction and DEAE Sepharose

C.-P. Chen; S.-C. Chang; W.-C. Vivian Yang

2007-01-01

251

The DIAMIND study: postpartum SMS reminders to women who have had gestational diabetes mellitus to test for type 2 diabetes: a randomised controlled trial - study protocol  

PubMed Central

Background Postpartum follow up of women who have been found to have gestational diabetes during pregnancy is essential because of the strong association of gestational diabetes with subsequent type 2 diabetes. Postal reminders have been shown to increase significantly attendance for oral glucose tolerance testing postpartum. It is possible that a short message service (text) reminder system may also be effective. This trial aims to assess whether a text message reminder system for women who have experienced gestational diabetes in their index pregnancy will increase attendance for oral glucose tolerance testing within six months after birth. Methods/Design Design: Single centre (Women’s and Children’s Hospital, South Australia), parallel group randomised controlled trial. Inclusion criteria: Women diagnosed with gestational diabetes in their index pregnancy (oral glucose tolerance test with fasting glucose ? 5.5 mmol/L and/or two hour glucose ? 7.8 mmol/L), with access to a mobile phone, whose capillary blood glucose profile measurements prior to postnatal discharge are all normal (fasting glucose < 6.0 mmol/L, postprandial glucoses < 8.0 mmol/L). Exclusion criteria: Pregestational diabetes mellitus, triplet/higher order multiple birth or stillbirth in the index pregnancy, requirement for interpreter. Trial entry and randomisation: Allocation to intervention will be undertaken using a telephone randomisation service (computer-generated random number sequence generation, with balanced variable blocks, and stratification by insulin requirement). Study groups: Women in the intervention group will receive a text reminder to attend for an oral glucose tolerance test at 6 weeks postpartum, with further reminders at 3 months and 6 months if they do not respond to indicate test completion. Women in the control group will receive a single text message reminder at 6 months postpartum. Blinding: Baseline data collection will be undertaken blinded. Blinding of participants and blinded collection of primary outcome data will not be possible for this study. Primary study outcome: Attendance for the oral glucose tolerance test within 6 months postpartum. Sample size: 276 subjects will be required to show an 18% absolute increase in the rate of attendance (?=0.05 two tailed, ?=80%, 5% loss to follow up) from 37% to 55% in the intervention group. Discussion Given the heightened risk of impaired glucose tolerance and type 2 diabetes in women who have had gestational diabetes, ensuring the highest possible rate of attendance for postpartum glucose tolerance testing, so that early diagnosis and intervention can occur, is important. A text message reminder system may prove to be an effective method for achieving improved attendance for such testing. This randomised controlled trial will assess whether such a system will increase rates of attendance for postpartum oral glucose tolerance testing in women who have experienced gestational diabetes. Trial Registration Australian New Zealand Clinical Trials Registry - ACTRN12612000621819

2013-01-01

252

Gestational diabetes mellitus and impaired glucose tolerance during pregnancy. Long-term effects on obesity and glucose tolerance in the offspring.  

PubMed

The effects of disturbances in carbohydrate metabolism during gestation were studied in the offspring of 1049 Pima Indian women who had no previous diagnosis of diabetes. Rates of fetal and maternal complications of pregnancy among women with diabetes first diagnosed during the pregnancy were similar to those among women in whom diabetes was recognized before gestation. Offspring, aged 5-19 yr, of women with abnormal glucose tolerance during pregnancy had a higher mean percent desirable weight and a higher mean postchallenge plasma glucose concentration than did offspring of women with normal glucose tolerance. Percent desirable weight and glucose concentration, however, were both lower than found in offspring of women with diabetes diagnosed before the pregnancy. Thus, metabolic events during pregnancy, as indicated by the detection of abnormal glucose tolerance during gestation, appear to have long-term effects on obesity and glucose tolerance in the offspring. PMID:3996763

Petitt, D J; Bennett, P H; Knowler, W C; Baird, H R; Aleck, K A

1985-06-01

253

Differential regulation of genes for feto-placental lipid pathways in pregnancy with gestational and type 1 diabetes  

PubMed Central

Objective Changes in metabolic homeostasis in pregnant diabetic women are potential determinants of increased adiposity of the fetus. The aim of this study was to characterize diabetes-induced changes in genes for fetal-placental energy metabolism in relation to fetal adiposity. Research Design and Methods Placentas of women with type 1 diabetes (T1DM), gestational diabetes (GDM) or no complications were analyzed using microarray profiling. Pattern of gene expression were assessed in primary placental cell cultures. Results Diabetes was associated with 49 alterations in gene expression at key steps in placental energy metabolism with 67 % related to lipid and 9 % related to glucose pathways. Preferential activation of lipid genes was observed in pregnancy with GDM. T1DM induced fewer lipid modifications but an enhancement of glycosylation and acylation pathways. Oleate enhanced expression of genes for fatty acid esterification and the formation of lipid droplets 3 times as much as glucose in cultured placental cells. Conclusions These results point to fatty acids as preferential lipogenic substrates for placental cells and, suggest that genes for fetal-placental lipid metabolism are selectively enhanced in GDM. The recruited genes may be instrumental in increasing transplacental lipid fluxes hence delivery of lipid substrates for fetal use.

Radaelli, T; Lepercq, J; Varastehpour, A; Basu, S; Catalano, PM; Hauguel-de Mouzon, S

2013-01-01

254

Pharmacokinetics of lidocaine and its metabolite in peridural anesthesia administered to pregnant women with gestational diabetes mellitus  

Microsoft Academic Search

Background  Peridural blockade with lidocaine, bupivacaine, and fentanyl is an anesthetic procedure extensively used in obstetrics, justifying\\u000a the pharmacokinetic study of these drugs during labor.\\u000a \\u000a \\u000a \\u000a Objective  To investigate the influence of the physiopathological changes of gestational diabetes mellitus (GDM) on the pharmacokinetics\\u000a of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women subjected to peridural anesthesia.\\u000a \\u000a \\u000a \\u000a Patients and methods  Ten normal pregnant women

Elaine Christine Dantas Moisés; Luciana de Barros Duarte; Ricardo de Carvalho Cavalli; Maria Paula Marques; Vera Lúcia Lanchote; Geraldo Duarte; Sérgio Pereira da Cunha

2008-01-01

255

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis  

PubMed Central

Background Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus. Methods We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case–control studies. Results Of the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14–24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT?=?46 (95% CI 28–115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI ?2.05 to ?1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99). Conclusion Pre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.

2012-01-01

256

Comparison of Insulin Lispro Protamine Suspension with NPH Insulin in Pregnant Women with Type 2 and Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes  

PubMed Central

Insulin therapy is still the gold standard in diabetic pregnancy. Insulin lispro protamine suspension is an available basal insulin analogue. Aim. To study pregnancy outcomes of women with type 2 and gestational diabetes mellitus when insulin lispro protamine suspension or human NPH insulin was added to medical nutrition therapy and/or short-acting insulin. Methods. In this retrospective study, for maternal outcome we recorded time and mode of delivery, hypertension, glycaemic control (fasting blood glucose and HbA1c), hypoglycemias, weight increase, and insulin need. For neonatal outcome birth weight and weight class, congenital malformations was recorded and main neonatal complications. Two-tail Student's t-test and chi-square test were performed when applicable; significant P < 0.05. Results. Eighty-nine pregnant women (25 with type 2 diabetes and 64 with gestational diabetes mellitus; 53 under insulin lispro protamine suspension and 36 under human NPH insulin) were recruited. Maternal and neonatal outcomes were quite similar between the two therapeutic approaches; however, insulin need was higher in NPH. At the end of pregnancy, eight women with gestational diabetes continued to use only basal insulin analogue. Conclusions. Pregnancy outcome in type 2 and gestational diabetes mellitus with insulin lispro protamine suspension was similar to that with NPH insulin, except for a lower insulin requirement.

Visalli, Natalia; Abbruzzese, Santina; Bongiovanni, Marzia; Napoli, Angela

2013-01-01

257

Loss of HGF/c-Met Signaling in Pancreatic ?-Cells Leads to Incomplete Maternal ?-Cell Adaptation and Gestational Diabetes Mellitus  

PubMed Central

Hepatocyte growth factor (HGF) is a mitogen and insulinotropic agent for the ?-cell. However, whether HGF/c-Met has a role in maternal ?-cell adaptation during pregnancy is unknown. To address this issue, we characterized glucose and ?-cell homeostasis in pregnant mice lacking c-Met in the pancreas (PancMet KO mice). Circulating HGF and islet c-Met and HGF expression were increased in pregnant mice. Importantly, PancMet KO mice displayed decreased ?-cell replication and increased ?-cell apoptosis at gestational day (GD)15. The decreased ?-cell replication was associated with reductions in islet prolactin receptor levels, STAT5 nuclear localization and forkhead box M1 mRNA, and upregulation of p27. Furthermore, PancMet KO mouse ?-cells were more sensitive to dexamethasone-induced cytotoxicity, whereas HGF protected human ?-cells against dexamethasone in vitro. These detrimental alterations in ?-cell proliferation and death led to incomplete maternal ?-cell mass expansion in PancMet KO mice at GD19 and early postpartum periods. The decreased ?-cell mass was accompanied by increased blood glucose, decreased plasma insulin, and impaired glucose tolerance. PancMet KO mouse islets failed to upregulate GLUT2 and pancreatic duodenal homeobox-1 mRNA, insulin content, and glucose-stimulated insulin secretion during gestation. These studies indicate that HGF/c-Met signaling is essential for maternal ?-cell adaptation during pregnancy and that its absence/attenuation leads to gestational diabetes mellitus.

Demirci, Cem; Ernst, Sara; Alvarez-Perez, Juan C.; Rosa, Taylor; Valle, Shelley; Shridhar, Varsha; Casinelli, Gabriella P.; Alonso, Laura C.; Vasavada, Rupangi C.; Garcia-Ocana, Adolfo

2012-01-01

258

Movement - uncontrolled or slow  

MedlinePLUS

... leg movements - uncontrollable; Slow involuntary movements of large muscle groups; Athetoid movements ... The slow twisting movements of muscles (athetosis) or jerky muscle ... including: Cerebral palsy Drug side effects Encephalitis ...

259

Factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes mellitus.  

PubMed

Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman's ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4-15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ?9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m(2) ± 6). Thirty-four percent of the women scored ?9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131). PMID:23124798

Nicklas, Jacinda M; Miller, Laura J; Zera, Chloe A; Davis, Roger B; Levkoff, Sue E; Seely, Ellen W

2013-11-01

260

Rapid screening test for gestational diabetes: public health need, market requirement, initial product design, and experimental results  

NASA Astrophysics Data System (ADS)

Gestational diabetes is a global epidemic where many urban areas in Southeast Asia have found prevalence rates as high as 20%, exceeding the highest prevalence rates in the developed world. It can have serious and life-threatening consequences for mothers and babies. We are developing two variants of a new, simple, low-cost rapid test for screening for gestational diabetes mellitus for use primarily in low-resource settings. The pair of assays, both semiquantitative rapid diagnostic strip tests for glycated albumin, require neither fasting nor an oral glucose challenge test. One variant is an extremely simple strip test to estimate the level of total glycated albumin in blood. The other, which is slightly more complex and expensive, is a test that determines the ratio of glycated albumin to total albumin. The screening results can be used to refer women to receive additional care during delivery to avoid birth complications as well as counseling on diet and exercise during and after pregnancy. Results with the latter test may also be used to start treatment with glucose-lowering drugs. Both assays will be read visually. We present initial results of a preliminary cost-performance comparison model evaluating the proposed test versus existing alternatives. We also evaluated user needs and schematic paper microfluidics-based designs aimed at overcoming the challenge of visualizing relatively narrow differences between normal and elevated levels of glycated albumin in blood.

Weigl, Bernhard H.; Zwisler, Greg; Peck, Roger; Abu-Haydar, Elizabeth

2013-03-01

261

Barriers to and Facilitators of Postpartum Follow-Up Care in Women with Recent Gestational Diabetes Mellitus: A Qualitative Study  

PubMed Central

Abstract Objectives Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. Methods We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Results Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9?kg/m2 (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. Conclusions Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.

Ennen, Christopher S.; Carrese, Joseph A.; Hill-Briggs, Felicia; Levine, David M.; Nicholson, Wanda K.; Clark, Jeanne M.

2011-01-01

262

The role of umbilical cord thickness and HbA1c levels for the prediction of fetal macrosomia in patients with gestational diabetes mellitus  

Microsoft Academic Search

Objective  The aim of this study was to investigate the effects of HbA1c levels and umbilical cord thickness upon birth weight, particularly\\u000a in pregestational and gestational diabetic patients.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Pregnant women were included in the study and were divided into two groups. The first group consisted of patients who were\\u000a diagnosed with pregestational or gestational diabetes mellitus. The control group consisted of

Birol Binbir; A. Ozgur Yeniel; A. Mete Ergenoglu; Mert Kazandi; Fuat Akercan; Sermet Sagol

263

LOW PLASMA VITAMIN B12 AND HIGH FOLATE CONCENTRATIONS IN PREGNANCY ARE ASSOCIATED WITH GESTATIONAL DIABESITY AND INCIDENT DIABETES  

PubMed Central

Aim To test the hypothesis that low plasma vitamin B12 concentrations combined with high folate concentrations in pregnancy are associated with higher incidence of gestational diabetes (GDM) and later diabetes. Methods Women (N=785) attending the antenatal clinics of the Holdsworth Memorial Hospital, Mysore, India had their anthropometry, insulin resistance (Homeostasis Model Assessment) and glucose tolerance assessed at 30 weeks gestation (100g Oral Glucose Tolerance Test/ OGTT; Carpenter-Coustan criteria), and five years after delivery (75g OGTT, WHO 1999). Vitamin B12 and folate concentrations in pregnancy were measured in stored frozen plasma samples. Results Low vitamin B12 concentrations (<150 pmol/l, B12 deficiency) were observed in 43% of women and low folate concentrations (<7 nmol/l) in 4%. Women with vitamin B12 deficiency had higher body mass index (BMI; P<0.001), sum of skinfolds (P<0.001), insulin resistance (P=0.02) and a higher incidence of GDM (8.7% v 4.6%; OR=2.14, P=0.02; P=0.1 after adjusting for maternal BMI) than non-deficient women. Among vitamin B12-deficient women the incidence of GDM increased with folate concentration (5.6%, 8.8%, 12.8% respectively from lowest to highest third; P for interaction=0.2). B12 deficiency during pregnancy predicted larger skinfolds, increased insulin resistance (P<0.05) and incident diabetes at 5-year follow-up (P=0.02, after adjusting for current BMI). Conclusion Maternal vitamin B12 deficiency is associated with increased adiposity and, in turn, with increased insulin resistance and GDM, especially in the presence of high folate concentrations. Vitamin B12 deficiency may be an important factor underlying the high risk of diabesity in south Asian Indians.

Krishnaveni, GV; Hill, JC; Veena, SR; Bhat, DS; Wills, AK; Chachyamma, KJ; Karat, SC; Yajnik, CS; Fall, CHD

2012-01-01

264

Comparison of the serum iron, ferritin levels and total iron-binding capacity between pregnant women with and without gestational diabetes  

PubMed Central

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy. GDM causes substantial morbidity and mortality and long- term complications. GDM-related risk factors have not been completely identified yet. Some studies have found relationship between increased serum ferritin and impaired oral glucose tolerance test but the relationship between serum ferritin and risk of GDM has been controversial. The aim of the study was to determine serum iron and ferritin levels and total iron binding capacity (TIBC) in women with GDM and comparison with normal pregnant women. Materials and Methods: This case-control study was performed among 200 pregnant women (case = 100, control = 100) who were referred to Yahya-Nejad Hospital in the second trimester in Babol from 2008 to 2009. GDM was diagnosed by impaired OGTT based on Carpenter and Coustan criteria. The 2 groups were matched in age, gestational age and parity. Results: High serum ferritin level increased the risk of gestational diabetes to 2.4-fold [OR = 2.4 (0.83-6.9) CI = 95% (P = 0.10)], while in those with low ferritin levels, the risk of developing gestational diabetes was reduced to 82% [OR = 0.8 with (0.08-0.37) CI = 95% (P = 0.001)]. Using the logistic regression model, after adjustment for BMI, the OR was 2.37 [(0.80-7.01) CI = 95% (P = 0.11)] for low ferritin level and OR = 0.20 [(0.09-0.44) CI = 95% (P = 0.0001)] for high ferritin level, which was statistically significant. Conclusion: The serum ferritin level was markedly higher in women with gestational diabetes than in normal pregnant women; therefore, high ferritin can be regarded as a significant risk factor for the development of gestational diabetes.

Amiri, Fatemeh Nasiri; Basirat, Zahra; Omidvar, Shabnam; Sharbatdaran, Majid; Tilaki, Karimollah Hajian; Pouramir, Mahdi

2013-01-01

265

An exploratory study of physical activity and lifestyle change associated with pregnancy and gestational diabetes mellitus and the implications for health promotion interventions  

Microsoft Academic Search

This research was an exploratory study of physical activity, pregnancy and Gestational Diabetes Mellitus (GDM) with implications for health promotion interventions. The study aimed to explore women’s physical activity levels before, during and after pregnancy including women who experienced GDM; factors that influenced levels of physical activity; women’s attitudes and information received in relation to physical activity; the influence of

Frances Mary Doran

2010-01-01

266

A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: A pilot study  

Microsoft Academic Search

OBJECTIVES: The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia, birth trauma, neonatal hypoglycemia, and operative delivery. The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study, by determining realistic accrual rates, and by

Peter Garner; Nan Okun; Erin Keely; George Wells; Sherry Perkins; Jacques Sylvain; Judy Belcher

1997-01-01

267

ADRB1 as a potential target for gene therapy of pregnancy induced hypertension and gestational diabetes mellitus.  

PubMed

Pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) do not cause any problems with recognition; however, their pathophysiologies are still not explained. Yet many authors suggest that adrenergic ?-1 receptor (ADRB1) plays a crucial role. The aim of this study was to evaluate the transcription activity of ADRB1 by using real-time polymerase chain reaction (PCR) in placenta from normal pregnancies and from PIH and GDM. Obtained findings demonstrated a significant increase in ADRB1 mRNA expression in the examined groups in comparison to the control (p = 0.03). Our data indicate a potential perspective of ADRB1 suppression gene therapy in the treatment of PIH and GDM. PMID:21806475

Wieclawek, Agnieszka; Slawska, Helena; Mazurek, Urszula

2011-08-01

268

Metabolic Changes in Urine during and after Pregnancy in a Large, Multiethnic Population-Based Cohort Study of Gestational Diabetes  

PubMed Central

This study aims to identify novel markers for gestational diabetes (GDM) in the biochemical profile of maternal urine using NMR metabolomics. It also catalogs the general effects of pregnancy and delivery on the urine profile. Urine samples were collected at three time points (visit V1: gestational week 8–20; V2: week 28±2; V3?10–16 weeks post partum) from participants in the STORK Groruddalen program, a prospective, multiethnic cohort study of 823 healthy, pregnant women in Oslo, Norway, and analyzed using 1H-NMR spectroscopy. Metabolites were identified and quantified where possible. PCA, PLS-DA and univariate statistics were applied and found substantial differences between the time points, dominated by a steady increase of urinary lactose concentrations, and an increase during pregnancy and subsequent dramatic reduction of several unidentified NMR signals between 0.5 and 1.1 ppm. Multivariate methods could not reliably identify GDM cases based on the WHO or graded criteria based on IADPSG definitions, indicating that the pattern of urinary metabolites above micromolar concentrations is not influenced strongly and consistently enough by the disease. However, univariate analysis suggests elevated mean citrate concentrations with increasing hyperglycemia. Multivariate classification with respect to ethnic background produced weak but statistically significant models. These results suggest that although NMR-based metabolomics can monitor changes in the urinary excretion profile of pregnant women, it may not be a prudent choice for the study of GDM.

Sachse, Daniel; Sletner, Line; M?rkrid, Kjersti; Jenum, Anne Karen; Birkeland, Kare I.; Rise, Frode; Piehler, Armin P.; Berg, Jens Petter

2012-01-01

269

Maternal Serum Heme-Oxygenase-1 (HO-1) Concentrations in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus  

PubMed Central

Background Heme oxygenase-1 (HO-1) concentrations have been recently reported to be elevated in impaired glucose tolerance and type 2 diabetes mellitus (T2DM). However, no study has examined the association between HO-1 concentrations and gestational diabetes mellitus (GDM). Methods In a case-control study, nested within a prospective cohort of pregnant women (186 GDM cases and 191 women who remained eu-glycemic through pregnancy), we assessed the association of maternal serum HO-1 concentrations, measured in samples collected at 16 weeks gestation, on average, with subsequent risk of GDM. Maternal serum HO-1 concentrations were determined using ELISA. We fitted multivariate logistic regression models to derive estimates of odds ratios (ORs) and 95% confidence intervals (CIs). Results Median serum HO-1 concentrations in early pregnancy were lower in women who subsequently developed GDM compared with those who did not (1.60 vs. 1.80 ng/mL, p-value?=?0.002). After adjusting for maternal age, race, family history of T2DM and pre-pregnancy body mass index, women with HO-1?3.05 ng/mL (highest decile) experienced a 74% reduction of GDM risk (95% CI; 0.09–0.77) compared with women whose concentrations were<1.23 ng/mL (lowest quartile). Conclusion Serum HO-1 concentrations were inversely associated with subsequent GDM risk. These findings underscore the role of oxidative stress in the pathogenesis of GDM. Additional studies are warranted to confirm the clinical utility of serum HO-1 in diagnosis of GDM, particularly in the early pregnancy.

Qiu, Chunfang; Hevner, Karin; Enquobahrie, Daniel A.; Williams, Michelle A.

2012-01-01

270

A3-3: Pre-Pregnancy Adiponectin Levels and Subsequent Risk of Gestational Diabetes Mellitus (GDM)  

PubMed Central

Background/Aims Adiponectin is an adipocyte-derived polypeptide with insulin-sensitizing properties that has been prospectively linked to the development of type 2 diabetes. Adiponectin levels decrease during the course of normal pregnancy. It is unknown whether pre-pregnancy adiponectin levels are related to risk of gestational diabetes mellitus (GDM), a common pregnancy complication and strong predictor of type 2 diabetes. Our study assessed prospectively whether serum total and high molecular weight (HMW) adiponectin concentrations measured before pregnancy are associated with subsequent risk of GDM. Methods We conducted a case-control study among normoglycemic women who took part in a multiphasic health checkup (MHC) exam at Kaiser Permanente Northern California between 1984–1996 and had a subsequent pregnancy before 2009 (255 GDM cases and 507 controls, matched on: year of exam, age at exam and age at pregnancy and number of intervening pregnancies). The MHC exam occurred on average 7 years before pregnancy. Results Pre-pregnancy total adiponectin and HMW concentrations were lower in women who developed GDM than controls (7.7 vs. 10.6 and 2.8 vs. 3.9 ?g/ml, respectively, P-values <0.001). Compared with women in the highest quartile of total adiponectin, women in the lowest quartile had an almost 4-fold increased risk of GDM after adjusting for insulin, hours since last food, race/ethnicity, family history of diabetes, education, BMI and parity (OR (95% CI): 3.83 (2.05–7.16)). Similar results were observed comparing the highest versus lowest quartile of HMW adiponectin (OR: 4.15 (2.20–7.83)). Conclusions The risk of GDM is increased among women with lower pre-pregnancy levels of adiponectin, suggesting decreased insulin sensitivity is present years before pregnancy. Measuring adiponectin may help identify women at high risk for GDM.

Hedderson, Monique; Darbinian, Jeanne; Ferrara, Assiamira

2013-01-01

271

Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians  

PubMed Central

Aim: We aimed to compare the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) criteria to diagnose gestational diabetes mellitus (GDM) in Chennai, India. Materials and Methods: We reviewed the retrospective data of 1351 pregnant women who underwent screening for GDM at four selected diabetes centers at Chennai (three private and one government). All women underwent an oral glucose tolerance test using 75g glucose load and fasting, 1-h, and 2-h samples were collected. The IADPSG and WHO criteria were compared for diagnosis of GDM. Results: A total of 839 women had GDM by either the IADPSG or the WHO criteria, of whom the IADPSG criteria identified 699 and the WHO criteria also identified 699 women as having GDM. However, only 599/839 women (66.6%) were identified by both criteria. Thus, 140/839 women (16.7%) were missed by both the IADPSG and the WHO criteria. 687/699 (98.2%) of the women with GDM were identified by the WHO criteria. In contrast, each value of IADPSG criteria i.e., fasting, 1 h, and 2 h identified only 12.5%, 14%, and 22%, respectively. Conclusions: A single WHO cut-point of 2 h > 140 mg/dl appears to be suitable for large-scale screening for GDM in India and other developing countries.

Nallaperumal, Sivagnanam; Bhavadharini, Balaji; Mahalakshmi, Manni Mohanraj; Maheswari, Kumar; Jalaja, Ramesh; Moses, Anand; Anjana, Ranjit Mohan; Deepa, Mohan; Ranjani, Harish; Mohan, Viswanathan

2013-01-01

272

Fetoplacental Vascular Endothelial Dysfunction as an Early Phenomenon in the Programming of Human Adult Diseases in Subjects Born from Gestational Diabetes Mellitus or Obesity in Pregnancy  

PubMed Central

Gestational diabetes mellitus (GDM) and obesity in pregnancy (OP) are pathological conditions associated with placenta vascular dysfunction coursing with metabolic changes at the fetoplacental microvascular and macrovascular endothelium. These alterations are seen as abnormal expression and activity of the cationic amino acid transporters and endothelial nitric oxide synthase isoform, that is, the “endothelial L-arginine/nitric oxide signalling pathway.” Several studies suggest that the endogenous nucleoside adenosine along with insulin, and potentially arginases, are factors involved in GDM-, but much less information regards their role in OP-associated placental vascular alterations. There is convincing evidence that GDM and OP prone placental endothelium to an “altered metabolic state” leading to fetal programming evidenced at birth, a phenomenon associated with future development of chronic diseases. In this paper it is suggested that this pathological state could be considered as a metabolic marker that could predict occurrence of diseases in adulthood, such as cardiovascular disease, obesity, diabetes mellitus (including gestational diabetes), and metabolic syndrome.

Leiva, Andrea; Pardo, Fabian; Ramirez, Marco A.; Farias, Marcelo; Casanello, Paola; Sobrevia, Luis

2011-01-01

273

The Risk of a Persistent Glucose Metabolism Impairment After Gestational Diabetes Mellitus Is Increased in Patients With Polycystic Ovary Syndrome  

PubMed Central

OBJECTIVE To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS). RESEARCH DESIGN AND METHODS The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM). RESULTS At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82–6.58). CONCLUSIONS Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM.

Palomba, Stefano; Falbo, Angela; Russo, Tiziana; Rivoli, Laura; Orio, Marcello; Cosco, Andrea Gregorio; Vero, Raffaella; Capula, Carmelo; Tolino, Achille; Zullo, Fulvio; Colao, Annamaria; Orio, Francesco

2012-01-01

274

Epigenetics of gestational diabetes mellitus and offspring health: the time for action is in early stages of life.  

PubMed

The epidemic increase of type 2 diabetes and obesity in developed countries cannot be explained by overnutrition, physical inactivity and/or genetic factors alone. Epidemiologic evidence suggests that an adverse intrauterine environment, in particular a shortage or excess of nutrients is associated with increased risks for many complex diseases later in life. An impressive example for the 'fetal origins of adult disease' is gestational diabetes mellitus which usually presents in 1% to >10% of third trimester pregnancies. Intrauterine hyperglycemia is not only associated with increased perinatal morbidity and mortality, but also with increased lifelong risks of the exposed offspring for obesity, metabolic, cardiovascular and malignant diseases. Accumulating evidence suggests that fetal overnutrition (and similarly undernutrition) lead to persistent epigenetic changes in developmentally important genes, influencing neuroendocrine functions, energy homeostasis and metabolism. The concept of fetal programming has important implications for reproductive medicine. Because during early development the epigenome is much more vulnerable to environmental cues than later in life, avoiding adverse environmental factors in the periconceptional and intrauterine period may be much more important for the prevention of adult disease than any (i.e. dietetic) measures in infants and adults. A successful pregnancy should not primarily be defined by the outcome at birth but also by the health status in later life. PMID:23515667

Lehnen, Harald; Zechner, Ulrich; Haaf, Thomas

2013-03-20

275

Gestational Age, Infant Birth Weight, and Subsequent Risk of Type 2 Diabetes in Mothers: Nurses' Health Study II  

PubMed Central

Introduction Women with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes (T2DM); however, little is known about the association between other common pregnancy complications (eg, preterm birth, macrosomia) and T2DM risk. We examined the associations between first-pregnancy preterm, postterm birth, low birth weight, and macrosomia with subsequent risk of T2DM. Methods We conducted a prospective cohort study of Nurses’ Health Study II (NHSII) participants; 51,728 women in the study had a single live birth and complete pregnancy history. NHSII confirmed incident diabetes mellitus through supplemental questionnaires. Participants were followed from year of first birth until 2005. We defined gestational age as very preterm (20 to ?32 weeks), moderate preterm (33 to ?37 weeks), term (38 to ?42 weeks), and postterm (?43 weeks). We defined low birth weight as an infant born at term weighing less than 5.5 pounds, and we defined macrosomia as an infant born at term weighing 10 pounds or more. We used Cox proportional hazards models, adjusting for potential confounders. Results Women with a very preterm birth (2%) had an increased T2DM risk (adjusted hazard ratio, 1.34; 95% confidence interval [CI], 1.05–1.71). This increased risk emerged in the decade following pregnancy. Macrosomia (1.5%) was associated with a 1.61 increased T2DM risk, after adjusting for risk factors, including GDM (95% CI, 1.24–2.08). This association was apparent within the first 5 years after pregnancy. Moderate preterm and term low birth weight did not significantly increase the risk of T2DM over the 35-year follow-up time. Conclusion Women who experienced a very preterm birth or had an infant that weighed 10 pounds or more may benefit from lifestyle intervention to reduce T2DM risk. If replicated, these findings could lead to a reduced risk of T2DM through improved primary care for women experiencing a preterm birth or an infant of nonnormal birth weight.

Karumanchi, S. Ananth; Hibert, Eileen L.; Mason, Susan M.; Vadnais, Mary A.; Hu, Frank B.; Rich-Edwards, Janet W.

2013-01-01

276

Applying current screening tools for gestational diabetes mellitus to a European population: is it time for change?  

PubMed

OBJECTIVE The optimal screening regimen for gestational diabetes mellitus (GDM) remains controversial. Risk factors used in selective screening guidelines vary. Given that universal screening is not currently adopted in our European population, we aimed to evaluate which selective screening strategies were most applicable. RESEARCH DESIGN AND METHODS Between 2007 and 2009, 5,500 women were universally screened for GDM, and a GDM prevalence of 12.4% using International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria was established. We retrospectively applied selective screening guidelines to this cohort. RESULTS When we applied National Institute for Health and Clinical Excellence (NICE), Irish, and American Diabetes Association (ADA) guidelines, 54% (2,576), 58% (2,801), and 76% (3,656) of women, respectively, had at least one risk factor for GDM and would have undergone testing. However, when NICE, Irish, and ADA guidelines were applied, 20% (120), 16% (101), and 5% (31) of women, respectively, had no risk factor and would have gone undiagnosed. Using a BMI ?30 kg/m(2) for screening has a specificity of 81% with moderate sensitivity at 48%. Reducing the BMI to ?25 kg/m(2) (ADA) increases the sensitivity to 80% with a specificity of 44%. Women with no risk factors diagnosed with GDM on universal screening had more adverse pregnancy outcomes than those with normal glucose tolerance. CONCLUSIONS This analysis provides a strong argument for universal screening. However, if selective screening were adopted, the ADA guidelines would result in the highest rate of diagnosis and the lowest number of missed cases. PMID:23757431

Avalos, Gloria E; Owens, Lisa A; Dunne, Fidelma

2013-06-11

277

Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus  

Microsoft Academic Search

SummaryBackground Pregnancy is associated with marked insulin resistance that seems to have little, if any, impact on the long-term risk of non-insulin-dependent diabetes mellitus (NIDDM) in the general population. The aim of this study was to test whether pregnancy would alter the risk of NIDDM among women with a high prevalence of pancreatic ?-cell dysfunction, as indicated by a history

R. K Peters; A Xiang; S. L Kjos; T. A Buchanan

1996-01-01

278

Insulin binding to trophoblast plasma membranes and placental glycogen content in well-controlled gestational diabetic women treated with diet or insulin, in well-controlled overt diabetic patients and in healthy control subjects  

Microsoft Academic Search

Summary  Insulin binding to trophoblast plasma membranes and the placental glycogen content were measured in twelve healthy women, in eleven well-controlled gestational diabetic women who were treated either with diet alone (n=4) or with insulin (n=7) and in 18 women with well-controlled overt diabetes mellitus (six White B; four White C; eight White D). The competitive binding assay was carried out

G. Desoye; H. H. Hofmann; P. A. M. Weiss

1992-01-01

279

Relationship between the adoption of preventive practices and the metabolic profile of women with prior gestational diabetes mellitus.  

PubMed

Women with prior gestational diabetes mellitus (GDM) are encouraged to adopt healthy lifestyle behaviours to prevent or delay type 2 diabetes. The objective was to examine the association between the adoption of preventive practices and the metabolic profile of women with prior GDM. Analyses included 181 women who had GDM between 2003 and 2010. The preventive practices examined included (i) regular physical activity (?150 min·week(-1)) assessed with the International Physical Activity Questionnaire; (ii) a healthy diet (score derived from the Alternate Healthy Eating Index and associated with a lower metabolic risk) evaluated from a food frequency questionnaire; and (iii) exclusive breastfeeding (?6 months). Women were classified according to the number of preventive practices adopted. Waist circumference, weight, and height were measured and body mass index (BMI) was calculated. Fasting insulinemia and glycemia were obtained and Matsuda index for insulin sensitivity was calculated. Nearly one-third of women adopted none of the listed preventive practices. For each increase of 1 preventive practice adopted, women were 30% less likely to have a BMI ? 25 kg·m(-2) (odds ratio (OR): 0.70, 95% confidence interval (CI) (0.50-0.98)), they were 34% less likely to have a waist circumference ? 88 cm (OR: 0.66, 95%CI (0.47-0.92)) and they were 33% less likely to have a Matsuda index for insulin sensitivity < 9.69 (OR: 0.67, 95%CI (0.48-0.94)). These results suggest that women with prior GDM who adopt the recommended preventive practices in the years following delivery are less likely to have lower insulin sensitivity, less likely to be overweight-obese, and less likely to be characterized by abdominal obesity. PMID:23176529

Gingras, Véronique; Paradis, Ann-Marie; Tchernof, André; Weisnagel, S John; Robitaille, Julie

2012-10-26

280

Serum Selenium Concentrations Correlate Significantly with Inflammatory Biomarker High-sensitive CRP Levels in Hungarian Gestational Diabetic and Healthy Pregnant Women at Mid-pregnancy  

Microsoft Academic Search

Selenium is an essential trace element and a component of various enzymes with antioxidant functions. High-sensitive C-reactive\\u000a protein (hsCRP) is an early indicator of increased lipid peroxidation. The serum selenium concentration, lipid parameters,\\u000a and hsCRP values of gestational diabetic pregnant women (GD), control pregnant women (CP), and healthy nonpregnant controls\\u000a (HC) were compared. Blood was taken between the 24th and

Jeannette Molnar; Zoltan Garamvolgyi; Magdolna Herold; Nora Adanyi; Aniko Somogyi; Janos Rigo

2008-01-01

281

Diabetes and Pregnancy  

MedlinePLUS

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When ... pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the ...

282

Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia.  

PubMed

Gestational diabetes mellitus (GDM) was diagnosed in 1928 of 35,253 (5.5%) tested pregnancies at the Mercy Maternity Hospital in Melbourne between 1979 and the end of 1988. Compared with women born in Australia and New Zealand, the incidence of GDM was significantly greater in women born on the Indian subcontinent (15%); in women born in Africa (9.4%), Vietnam (7.3%), Mediterranean countries (7.3%), and Egypt and Arabic countries (7.2%); and in Chinese (13.9%) and other Asian (10.9%) women. There was no significant difference for women born in the United Kingdom and northern Europe (5.2%), Oceania (5.7%), North America (4.0%), or South America (2.2%). With the World Health Organization criteria as a guide to the severity of hyperglycemia, compared with mothers born in Australia and New Zealand, there were significant increases in the incidences of the more severe grades of GDM in parturients born in the Mediterranean region, Asia, the Indian subcontinent, Egypt, and Arabic countries. The incidence of GDM increased significantly in all racial groups, rising from 3.3% during 1979-1983 to 7.5% during 1984-1988. PMID:1748263

Beischer, N A; Oats, J N; Henry, O A; Sheedy, M T; Walstab, J E

1991-12-01

283

The usefulness of plasma asymmetric dimethylarginine (ADMA) levels and tissue doppler echocardiography for heart function in term infants born to mothers with gestational diabetes mellitus.  

PubMed

Abstract Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes. Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group (n?=?25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured. Results: In the first analysis, 10 patients (40%) had a septal thickness of 6?mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ?6?mm and the group with <6?mm. Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn. PMID:23614659

Arslan, Derya; Oran, Bulent; Vatansev, Husamettin; Cimen, Derya; Guvenc, Osman

2013-05-24

284

The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus - lessons from projects funded by the World Diabetes Foundation  

PubMed Central

Background To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, need for repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Conclusion Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level.

Nielsen, Karoline Kragelund; de Courten, Maximilian; Kapur, Anil

2012-01-01

285

An infant born to a mother with gestational diabetes presenting with 49,XXXXY syndrome and renal agenesis-a case report.  

PubMed

49,XXXXY is a rare sex chromosome polysomy with an incidence of 1 in 85 000 male births. It has a characteristic triad of mental retardation, skeletal malformation and hypogonadism. This is the first case report of a child with 49,XXXXY syndrome and renal agenesis. This child was referred for genetic testing at 14 years of age due to facial dysmorphism and hypergonadotropic hypogonadism. He had coarse facial features, cryptorchidism of the right testis, genu valgus deformities, and patent ductus arteriosus which are known associations of 49,XXXXY syndrome. He also had agenesis of the right kidney, hydronephrosis of the left kidney with hydroureter which is not a known association of 49,XXXXY syndrome. The patient was the offspring of a mother with gestational diabetes. There is a strong correlation between maternal diabetes and congenital anomalies, especially renal and cardiovascular anomalies. Additionally, it has been noted that gestational diabetes increases the incidence of chromosomal aneuploidies. The teratogenic effects of maternal diabetes during embryogenesis may be the causative factor for the final phenotype of 49,XXXXY syndrome and renal agenesis. PMID:23032147

Sumathipala, Dulika; Gamage, Thilini; Wijesiriwardena, Bandula; Jayasekara, Rohan W; Dissanayake, Vajira H W

2012-10-02

286

An Infant Born to a Mother with Gestational Diabetes Presenting with 49,XXXXY Syndrome and Renal Agenesis-A Case Report  

PubMed Central

49,XXXXY is a rare sex chromosome polysomy with an incidence of 1 in 85 000 male births. It has a characteristic triad of mental retardation, skeletal malformation and hypogonadism. This is the first case report of a child with 49,XXXXY syndrome and renal agenesis. This child was referred for genetic testing at 14 years of age due to facial dysmorphism and hypergonadotropic hypogonadism. He had coarse facial features, cryptorchidism of the right testis, genu valgus deformities, and patent ductus arteriosus which are known associations of 49,XXXXY syndrome. He also had agenesis of the right kidney, hydronephrosis of the left kidney with hydroureter which is not a known association of 49,XXXXY syndrome. The patient was the offspring of a mother with gestational diabetes. There is a strong correlation between maternal diabetes and congenital anomalies, especially renal and cardiovascular anomalies. Additionally, it has been noted that gestational diabetes increases the incidence of chromosomal aneuploidies. The teratogenic effects of maternal diabetes during embryogenesis may be the causative factor for the final phenotype of 49,XXXXY syndrome and renal agenesis. Conflict of interest:None declared.

Sumathipala, Dulika; Gamage, Thilini; Wijesiriwardena, Bandula; Jayasekara, Rohan W.; Dissanayake, Vajira H.W.

2012-01-01

287

Effect of addition of either sitagliptin or pioglitazone in patients with uncontrolled type 2 diabetes mellitus on metformin: A randomized controlled trial  

PubMed Central

Objective: To compare and study the dipeptidy1 peptidase-4 (DPP-4) inhibitors in combination with metformin against established combination therapies. Materials and Methods: This 16-week study was designed to compare sitagliptin versus pioglitazone as add-on therapy in patients of type 2 diabetes mellitus inadequately controlled with metformin alone. Fifty-two patients were randomized into two groups to receive either sitagliptin 100 mg (group 1) or pioglitazone 30 mg (group 2) in addition to metformin. The primary efficacy end point was change in HbA1c. Secondary end points included change in fasting plasma glucose (FPG), body weight and lipid profile. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. Both the groups had a significant decrease in HbA1c. Results: There was no significant difference between mean reductions in FPG in both the groups. There was a significant decrease in the mean body weight and body mass index in group 1 in contrast to the significant increase in the same in group 2. Both the treatment groups reported a significant decrease in High-density lipoprotein (HDL-C) and Triglyceride. Conclusion: Sitagliptin was well tolerated without any incidence of hypoglycemia. It was concluded that sitagliptin as an add-on to metformin is as effective and well tolerated as pioglitazone.

Chawla, Shalini; Kaushik, Nitin; Singh, Narinder Pal; Ghosh, Raktim Kumar; Saxena, Alpana

2013-01-01

288

Cost-Effectiveness of Lifestyle Counselling as Primary Prevention of Gestational Diabetes Mellitus: Findings from a Cluster-Randomised Trial  

PubMed Central

Aims The aim was to evaluate the cost-effectiveness of primary prevention of gestational diabetes mellitus (GDM) through intensified counselling on physical activity, diet, and appropriate weight gain among the risk group. Materials and Methods The cost-effectiveness analysis was based on data from a cluster-randomised controlled GDM prevention trial carried out in primary health-care maternity clinics in Finland. Women (n?=?399) with at least one risk factor for GDM were included. The incremental cost-effectiveness ratio (ICER) was calculated in terms of birth weight, 15D, and perceived health as measured with a visual analogue scale (VAS). A bootstrap technique for cluster-randomised samples was used to estimate uncertainty around a cost-effectiveness acceptability curve. Results The mean total cost in the intervention group was €7,763 (standard deviation (SD): €4,511) and in the usual-care group was €6,994 (SD: €4,326, p?=?0.14). The mean intervention cost was €141. The difference for costs in the birth-weight group was €753 (95% CI: ?250 to 1,818) and in effects for birth weight was 115 g (95% CI: 15 to 222). The ICER for birth weight was almost €7, with 86.7% of bootstrap pairs located in the north-east quadrant, indicating that the intervention was more effective and more expensive in birth weight terms than the usual care was. The data show an 86.7% probability that each gram of birth weight avoided requires an additional cost of €7. Conclusions Intervention was effective for birth weight but was not cost-effective for birth weight, 15D, or VAS when compared to the usual care. Trial Registration ISRCTN 33885819.

Kolu, Paivi; Raitanen, Jani; Rissanen, Pekka; Luoto, Riitta

2013-01-01

289

Higher Fetal Insulin Resistance in Chinese Pregnant Women with Gestational Diabetes Mellitus and Correlation with Maternal Insulin Resistance  

PubMed Central

Objective The aim of this study was to determine the effect of gestational diabetes mellitus (GDM) on fetal insulin resistance or ?-cell function in Chinese pregnant women with GDM. Measurements Maternal fasting blood and venous cord blood samples (reflecting fetal condition) were collected in 65 well-controlled Chinese GDM mothers (only given dietary intervention) and 83 control subjects. The insulin, glucose and proinsulin concentrations of both maternal and cord blood samples were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) and the proinsulin-to-insulin ratios (an indicator of fetal ?-cell function) were calculated in maternal and cord blood respectively. Results Both maternal and fetal levels of insulin, proinsulin and HOMA-IR but not proinsulin-to-insulin ratios were significantly higher in the GDM group than in the control group (maternal insulin, 24.8 vs. 15.4 µU/mL, P?=?0.004, proinsulin, 23.3 vs. 16.2 pmol/L, P?=?0.005, and HOMA-IR, 5.5 vs. 3.5, P?=?0.041, respectively; fetal: insulin, 15.1 vs. 7.9 µU/mL, P<0.001, proinsulin, 25.8 vs. 15.1 pmol/L, P?=?0.015, and HOMA-IR, 2.8 vs. 1.4, P?=?0.017, respectively). Fetal HOMA-IR but not proinsulin-to-insulin ratios was significantly correlated to maternal HOMA-IR (r?=?0.307, P?=?0.019), in the pregnant women with GDM. Conclusions Fetal insulin resistance was higher in Chinese pregnant women with GDM than control subjects, and correlated with maternal insulin resistance.

Wang, Qiuwei; Huang, Ruiping; Yu, Bin; Cao, Fang; Wang, Huiyan; Zhang, Ming; Wang, Xinhong; Zhang, Bin; Zhou, Hong; Zhu, Ziqiang

2013-01-01

290

Analysis of phosphatidylinositol 3-kinase activation in the adipose tissue of gestational diabetes mellitus patients and insulin resistance.  

PubMed

The P85 regulatory subunit protein and gene expression and P110 catalylic subunit activity of phosphatidylinositol 3-kinase (PI-3K) were investigated in adipose tissue of patients with gestational diabetes mellitus (GDM) in order to explore the molecular mechanisms of insulin resistance (IR) of GDM. Samples from patients with GDM (n=50), and controls (n=50) were collected. Fasting insulin (FIN) was determined by radioimmunoassay. Fasting plasma glucose (FPG) was measured by oxidase assay. Western blot technique was used to detect the levels of PI-3K P85 subunit in adipose tissues of patients with GDM. The mRNA expression of PI-3K P85 subunit was detected by reverse transcription polymerase chain reaction (RT-PCR) method in the adipose tissue. PI-3K activity was examined by immunoprecipitation, thin-layer chromatography and gamma scintillation counting. The results were analyzed statistically. It was found that the levels of FPG, FIN and HOMA-IR in GDM group were significantly higher than those in control group (all P<0.01). There was no significant difference in the protein and gene expression of PI-3K P85 subunit between GDM group and control group (P>0.05). PI-3K activity was significantly decreased to 82.89% in GDM group as compared with control group (P<0.01) and negatively correlated with HOMA-IR (r=-0.75, P<0.01). It was concluded that PI-3K in GDM patients may be involved in the insulin signaling pathway, resulting in IR of GDM. PMID:20714879

Chu, Yongli; Liu, Wenjuan; Cui, Qing; Feng, Guijiao; Wang, Yan; Jiang, Xueqiang

2010-08-17

291

History of infertility and risk of gestational diabetes mellitus: a prospective analysis of 40,773 pregnancies.  

PubMed

Studies of delayed conception and risk of gestational diabetes (GDM) are sparse, although common underlying mechanisms are plausible, including insulin resistance and inflammation. The association between a history of infertility and GDM was assessed prospectively among 40,773 eligible pregnancies in the US Nurses' Health Study II cohort (1989-2001). Biennial questionnaires provided updated information on infertility and several lifestyle and health-related characteristics. Multivariable log-binomial models with generalized estimating equations were used to compute risk ratios and 95% confidence intervals, adjusting for age, prepregnancy body mass index (weight (kg)/height (m)(2)), and additional potential confounders. GDM occurred among 1,405 (5.2%) women. A prepregnancy history of infertility was reported by 5,497 (20.5%) participants and was significantly associated with a 39% greater risk of GDM (risk ratio (RR) = 1.39, 95% confidence interval (CI): 1.24, 1.57; P < 0.001). Underlying reasons for infertility associated with GDM included ovulation disorders (RR = 1.52, 95% CI: 1.23, 1.87; P < 0.001) and tubal blockage (RR = 1.83, 95% CI: 1.20, 2.77; P = 0.005). The association of cervical mucus disorder with GDM was of borderline significance (RR = 1.70, 95% CI: 0.88, 3.30; P = 0.11). Endometriosis (RR = 1.27, 95% CI: 0.70, 2.31; P = 0.43) and male factor infertility (RR = 1.12, 95% CI: 0.78, 1.61; P = 0.55) were not associated with GDM risk. These novel findings suggest that infertility, particularly from ovulation disorders and tubal blockage, is associated with an increased GDM risk. Further research is needed to identify mechanisms or common underlying metabolic dysfunction explaining these observations. PMID:23956097

Tobias, Deirdre K; Chavarro, Jorge E; Williams, Michelle A; Buck Louis, Germaine M; Hu, Frank B; Rich-Edwards, Janet; Missmer, Stacey A; Zhang, Cuilin

2013-08-15

292

Evaluation of clinical indicators and social context for developing lifestyle modification programs after gestational diabetes mellitus: a case study of a cohort of women in the Illawarra region, Australia  

Microsoft Academic Search

Women with previous gestational diabetes mellitus (GDM) have a 30-50% future risk of developing Type 2 diabetes mellitus (T2DM), a global public health problem. Preventive approaches would target diet and physical activity behaviours yet little is known about these lifestyle parameters in this group. This thesis describes the diet, physical activity and risk factor profile of a sample of women

Janelle Barnard

2005-01-01

293

Screening, diagnosis and services for women with gestational diabetes mellitus (GDM) in New Zealand: a technical report from the National GDM Technical Working Party.  

PubMed

Rates of gestational diabetes mellitus (GDM) and Type 2 diabetes in pregnancy are increasing with the epidemic of obesity. GDM is associated with significant perinatal morbidity and future risk of permanent diabetes in the mother and obesity and diabetes in the offspring. The recent Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) has shown maternal and perinatal benefits of managing GDM once diagnosed. The criteria for GDM are under review following the recent completion of the Hyperglycaemia and Adverse Perinatal Outcomes study (HAPO). In New Zealand, the approach to identifying women with GDM or undiagnosed Type 2 diabetes has varied. The National GDM Technical Working Party reviewed the available data in the New Zealand context and recommend that (1) All pregnant women are offered screening for GDM backed up with relevant educational, systems and materials for health professionals and the women; (2) Criteria for GDM should remain unchanged pending further information (which should be actively sought); (3) Women at high risk of undiagnosed Type 2 diabetes in pregnancy should be screened at booking: the HbA1c was recommended as a practical initial screening test, but further research is needed; and (4) A structured, audited, population-based approach to managing women with GDM should be introduced in each district. PMID:18364758

Simmons, David; Rowan, Janet; Reid, Rosemary; Campbell, Norma

2008-03-14

294

Diabetes diet - gestational  

MedlinePLUS

... complex carbohydrates (such as bread, cereal, pasta, and rice) Lower in foods that have a lot of ... in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, ...

295

Retinol-Binding Protein 4: A Novel Adipokine Implicated In the Genesis of LGA in the Absence of Gestational Diabetes Mellitus  

PubMed Central

Objective Adipokines (cytokines produced by adipose tissue) play a major role in the control of body weight and energy distribution. Retinol-binding protein (RBP) 4, only recently recognized as an adipokine, has been proposed to modulate systemic insulin sensitivity. The goal of this study was to determine whether there is an association between maternal plasma RBP4 concentration and the birth of a large-for-gestational-age (LGA) newborn in women with and without gestational diabetes mellitus (GDM). Study design This cross-sectional study included pregnant women at term in the following groups: 1) normal pregnancy with an appropriate-for-gestational-age (AGA) neonate (n=64); 2) normal pregnancy with an LGA neonate (n=44); 3) GDM with an AGA neonate (n=55); and 4) GDM with an LGA neonate (n=42). Maternal plasma RBP4 concentration was determined by ELISA. Parametric and non-parametric statistics were used for analyses. Results 1) Patients with GDM, either with AGA or LGA neonates, had a higher median plasma concentration of RBP4 than normal pregnant women who delivered an AGA neonate (p=0.01 and p=0.008, respectively); 2) mothers without GDM but with LGA neonates had a higher median plasma concentration of RBP4 than those with normal pregnancy and AGA newborns (p=0.001); 3) these findings remained significant after adjusting for maternal age, BMI and gestational age at blood sampling. Conclusion GDM is characterized by alterations in maternal circulating RBP4 concentrations akin to those of Type 2 DM. Retinol binding protein 4 concentrations in maternal plasma may play a role in accelerated fetal growth in the absence of overt carbohydrate intolerance.

Mazaki-Tovi, Shali; Romero, Roberto; Vaisbuch, Edi; Kusanovic, Juan Pedro; Chaiworapongsa, Tinnakorn; Kim, Sun Kwon; Mittal, Pooja; Dong, Zhong; Pacora, Percy; Yeo, Lami; Hassan, Sonia S.

2012-01-01

296

An evaluation of Croi MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial.  

PubMed

BACKGROUND: Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croi MyAction intensive lifestyle modification programme for women with prior GDM. METHODS: A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croi MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croi MyAction. Croi MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691).Trial registration: Current Controlled Trials ISRCTN41202110. PMID:23782471

Infanti, Jennifer J; Dunne, Fidelma P; O Dea, Angela; Gillespie, Paddy; Gibson, Irene; Glynn, Liam G; Noctor, Eoin; Newell, John; McGuire, Brian E

2013-05-01

297

An evaluation of Cro? MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial  

PubMed Central

Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. Methods/Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction (impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)), are randomly assigned to a control arm (n = 27) or to the Croí MyAction intervention group (n = 27). The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required. The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction. Croí MyAction involves 2.5 hour sessions once per week (for 12 weeks) comprising a group exercise programme, group health promotion or education seminars, and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions. Randomisation and allocation to the intervention arms is carried out by an independent researcher, ensuring that the allocation sequence is concealed from study researchers until the interventions are assigned. The primary analysis is based on glucose dysfunction, comparing a mean reduction in fasting plasma glucose (FPG) levels on a 75 gram oral glucose tolerance test (OGTT) in the two groups at a one-year, post-intervention follow-up. The trial is funded by the Irish Health Research Board (HRB). Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee, Galway University Hospitals, Health Service Executive of Ireland (Ref: C.A.691). Trial registration Current Controlled Trials ISRCTN41202110.

2013-01-01

298

Design of FitFor2 study: the effects of an exercise program on insulin sensitivity and plasma glucose levels in pregnant women at high risk for gestational diabetes  

Microsoft Academic Search

BACKGROUND: Pregnancy is a period in the life of women that is often associated with decreased daily physical activity and\\/or exercise. However, maintaining adequate levels of daily physical activity during pregnancy is important for mother and child. Studies suggest that moderate daily physical activity and exercise during pregnancy are associated with reductions in the risk of gestational diabetes mellitus (GDM).

Nicolette Oostdam; Mireille NM van Poppel; Elisabeth MW Eekhoff; Maurice GAJ Wouters; Willem van Mechelen

2009-01-01

299

Gestational ageism.  

PubMed

Published guidelines for resuscitation of extremely premature infants emphasize the importance of the gestational age of the infant. However, some ethicists and pediatricians have questioned these guidelines, suggesting that this may represent a form of discrimination. A policy of nonresuscitation of elderly patients older than a certain age would constitute a form of ageism and would likely be unacceptable to the broader community. Are resuscitation decisions for premature newborn infants analogous to resuscitation of elderly patients? Are current neonatal resuscitation guidelines discriminatory? ?This article looks at the relationship between discrimination based on gestational age and chronological age. There are 2 levels of gestational ageism and 2 separate strands of argument against gestational age guidelines. I conclude that resuscitation decisions for premature infants share many features with those for elderly patients, although there are also some relevant differences. I propose the use of gestational age equivalence as an alternative framework for practice. PMID:22665031

Wilkinson, Dominic J C

2012-06-01

300

A Randomized Controlled Trial Investigating the Effects of a Low-Glycemic Index Diet on Pregnancy Outcomes in Gestational Diabetes Mellitus  

PubMed Central

OBJECTIVE The prevalence of gestational diabetes mellitus (GDM) is rising. There is little evidence to demonstrate the effectiveness of one dietary therapy over another. We aimed to investigate the effect of a low–glycemic index (LGI) versus a conventional high-fiber diet on pregnancy outcomes, neonatal anthropometry, and maternal metabolic profile in GDM. RESEARCH DESIGN AND METHODS Ninety-nine women (age 26–42 years; mean ± SD prepregnancy BMI 24 ± 5 kg/m2) diagnosed with GDM at 20–32 weeks’ gestation were randomized to follow either an LGI (n = 50; target glycemic index [GI] ~50) or a high-fiber moderate-GI diet (HF) (n = 49; target GI ~60). Dietary intake was assessed by 3-day food records. Pregnancy outcomes were collected from medical records. RESULTS The LGI group achieved a modestly lower GI than the HF group (mean ± SEM 47 ± 1 vs. 53 ± 1; P < 0.001). At birth, there was no significant difference in birth weight (LGI 3.3 ± 0.1 kg vs. HF 3.3 ± 0.1 kg; P = 0.619), birth weight centile (LGI 52.5 ± 4.3 vs. HF 52.2 ± 4.0; P = 0.969), prevalence of macrosomia (LGI 2.1% vs. HF 6.7%; P = 0.157), insulin treatment (LGI 53% vs. HF 65%; P = 0.251), or adverse pregnancy outcomes. CONCLUSIONS In intensively monitored women with GDM, an LGI diet and a conventional HF diet produce similar pregnancy outcomes.

Louie, Jimmy Chun Yu; Markovic, Tania P.; Perera, Nimalie; Foote, Deborah; Petocz, Peter; Ross, Glynis P.; Brand-Miller, Jennie C.

2011-01-01

301

Skeletal Muscle MnSOD, Mitochondrial Complex II, and SIRT3 Enzyme Activities Are Decreased in Maternal Obesity During Human Pregnancy and Gestational Diabetes Mellitus.  

PubMed

Context: Insulin resistance and systemic oxidative stress are prominent features of pregnancies complicated by maternal obesity or gestational diabetes mellitus (GDM). The role of skeletal muscle oxidative stress or mitochondrial capacity in obese pregnant women or obese women with GDM is unknown. Objective: We investigated whether obese pregnant women, compared with normal weight (NW) pregnant women, demonstrate decreased skeletal muscle mitochondrial enzyme activity and elevated markers of oxidative stress, and if these differences are more severe in obese women diagnosed with GDM. Design: We measured mitochondrial enzyme activity and markers of oxidative stress in skeletal muscle tissue from NW pregnant women (n = 10), obese pregnant women with normal glucose tolerance (NGT; n = 10), and obese pregnant women with GDM (n = 8), undergoing cesarean delivery (?37 wk gestation). Results: Electron transport complex-II and manganese superoxide dismutase (MnSOD) enzyme activities were decreased in obese-NGT and obese-GDM, compared with NW women. The glutathione redox ratio (GSH:GSSG) was decreased in obese-NGT and obese-GDM, indicative of increased oxidative stress. Mitochondrial sirtuin (SIRT)3 mRNA content and enzyme activity were lower in skeletal muscle of obese-NGT and obese-GDM women. Importantly, acetylation of MnSOD, a SIRT3 target, was increased in obese-NGT and obese-GDM vs NW women and was inversely correlated with SIRT3 activity (r = -0.603), suggesting a mechanism for reduced MnSOD activity. Conclusions: These data show that obese pregnant women demonstrate decreased skeletal muscle mitochondrial respiratory chain enzyme activity and decreased mitochondrial antioxidant defense. Furthermore, reduced skeletal muscle SIRT3 activity may play a role in the increased oxidative stress associated with pregnancies complicated by obesity. PMID:23956348

Boyle, Kristen E; Newsom, Sean A; Janssen, Rachel C; Lappas, Martha; Friedman, Jacob E

2013-08-16

302

Introduction to Type 2 Diabetes (Revised).  

National Technical Information Service (NTIS)

Contents: What is Type 2 Diabetes; The Cycle of Type 2 Diabetes; Tupe 1 vs Type 2; Risk Factors for Type 2 Diabetes in American Indians; Diagnosing Diabetes; Diagnostic Criteria for Diabetes Mellitus, Impaired Glucose Tolerance, and Gestational Diabetes; ...

B. Drabant K. Acton B. Tolbert

1996-01-01

303

Insulin resistance as estimated by the homeostatic method at diagnosis of gestational diabetes: estimation of disease severity and therapeutic needs in a population-based study  

PubMed Central

Background Chronic insulin resistance, exacerbated in the course of pregnancy, is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). We hypothesise that the degree of insulin resistance, assessed at diagnosis of GDM, is a parameter of its pathophysiologic heterogeneity and/or severity. Thus, it offers potential to open new avenues for the personalization of therapy in affected women. Methods 1254 Polish Caucasian women with GDM were recruited into the study. The following parameters were assessed in the course of the study: body mass index (BMI), parity, weight gain during pregnancy, glycated haemoglobin, glucose level during an oral glucose tolerance test (OGTT), insulin, insulin resistance and insulin secretion. The severity of GDM was assessed based on insulin use and daily insulin dose during gestation. In order to evaluate insulin secretion and insulin resistance the homeostatic method was used (HOMA-B and HOMA-IR, respectively). We compared all the metabolic parameters and methods of treatment of GDM in women subdivided by quartiles of insulin resistance. Results The HOMA-IR in the whole population ranged from 0.34 to 20.39. The BMI, fasting insulin, fasting glucose and insulin dose per day increased along with increasing quartiles (HOMA-IR?>?1.29). We observed a decrease of HOMA-B in the third quartile (1.92-2.89) compared with the first quartile (0.34-1.29). Insulin treatment was associated with HOMA-IR (<1.29 vs. >2.89), OR: 3.37, fasting glucose (?6.11 vs. >6.11 mmol/dl), OR: 2.61, age (?30 vs. >30 y. o.), OR: 1.54, and BMI (<25 vs. ?25 kg/m2), OR: 1.45. Maximum insulin dose was associated with HOMA-IR, OR: 2.00, after adjustment for family history of diabetes, and 2-h OGTT glucose. Conclusion Insulin resistance assessed by the HOMA index at diagnosis is associated with the severity and pathophysiological heterogeneity of GDM. A HOMA-IR >1.29 points to the major role of insulin resistance, indicating the need for a treatment aimed at improving tissue sensitivity to insulin. A HOMA-IR 1.29-2.89 suggests reduced insulin secretion, which is an indication for the introduction of insulin therapy. A HOMA-IR >2.89 indicates insufficient compensation for insulin resistance, which suggests the need for a treatment aimed at improving susceptibility of tissues to insulin combined with insulin therapy.

2013-01-01

304

Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus  

PubMed Central

Background Diet therapy is the cornerstone for the management of gestational diabetes mellitus (GDM). Carbohydrate is the primary nutrient affecting postprandial blood glucose levels. Hence, knowledge of food containing carbohydrates can assist women with GDM optimize glycemic control. Despite that, there is a paucity of research on carbohydrate-related knowledge of women with GDM. The United Arab Emirates (UAE) has one of the highest prevalence of diabetes (19.2%) in the world. This study compared diet and knowledge of carbohydrate-containing foods among pregnant women with and without GDM in the UAE. Methods The sample consisted of multi-ethnic women with GDM (n?=?94) and a control group of healthy pregnant women (n?=?90) attending prenatal clinics in three hospitals in Al Ain, UAE. Data were collected using a questionnaire and a 24-hour recall. Knowledge of food sources of carbohydrate, dietary patterns, and nutrient intakes of the two groups were compared. Results There were no significant differences in the mean knowledge score of food sources of carbohydrate between women with GDM and that of pregnant women without GDM. Similarly, there were no significant differences in energy and nutrient intakes between the two groups with the exception of percent energy from protein. Women with GDM reported significantly lower intake of fruits and fruit juices (P?=?0.012) and higher consumption of milk and yogurt (P?=?0.004) compared to that of women without GDM. Twenty-two percent of women with GDM indicated they never visited a dietitian for counseling while 65% reported they visited a dietitian only once or twice during the pregnancy. Predictors of carbohydrate knowledge score were perceived knowledge of diet and GDM and parity among women with GDM and parity and educational level among those without GDM. Conclusion The results of the study highlight the urgent need to provide nutrition education for women with GDM in the UAE.

Ali, Habiba I.; Jarrar, Amjad H.; El Sadig, Mohamed; B. Yeatts, Karin

2013-01-01

305

Impaired non-esterified fatty acid suppression to intravenous glucose during late pregnancy persists postpartum in gestational diabetes: a dominant role for decreased insulin secretion rather than insulin resistance  

Microsoft Academic Search

Aims\\/hypothesis  Non-esterified fatty acids are implicated in the pathogenesis of gestational (GDM) and type 2 diabetes. We examined the relationship between NEFA dynamics, insulin resistance and beta cell dysfunction in women with GDM in late pregnancy and postpartum.Methods  A total of 19 Caucasian women with GDM and 19 healthy pregnant women matched for BMI and age underwent an IVGTT in the third

K. A. McLachlan; R. Boston; F. P. Alford

2005-01-01

306

The Common C49620T Polymorphism in the Sulfonylurea Receptor Gene SUR1 (ABCC8) in Patients with Gestational Diabetes and Subsequent Glucose Metabolism Abnormalities  

PubMed Central

Aim. The aim of this study is to investigate the relationship between the common C49620T polymorphism in the sulfonylurea receptor (SUR1) gene and glucose metabolism, ?-cell secretory function and insulin resistance in women with a history of gestational diabetes (GDM). Material and Methods. Study group included 199 women, diagnosed GDM within the last 5–12 years and control group of comparable 50 women in whom GDM was excluded during pregnancy. Blood glucose and insulin levels were measured during oral glucose tolerance test. Indices of insulin resistance (HOMA-IR) and ?-cell function (HOMA %B) were calculated. In all patients, the C49620T polymorphism in intron 15 of the SUR1 gene was determined. Results. The distribution of the studied polymorphism in the two groups did not differ from each other (?2 = 0.34, P = 0.8425). No association between the distribution of polymorphisms and coexisting glucose metabolism disorders (?2 = 7,13, P = 0, 3043) was found. No association was also observed between the polymorphism and HOMA %B or HOMA-IR. Conclusions. The polymorphism C49620T in the SUR1 gene is not associated with insulin resistance and/or insulin secretion in women with a history of GDM and does not affect the development of GDM, or the development of glucose intolerance in the studied population.

Moleda, Piotr; Binczak-Kuleta, Agnieszka; Homa, Katarzyna; Safranow, Krzysztof; Celewicz, Zbigniew; Syrenicz, Anhelli; Stefanski, Adam; Fronczyk, Aneta; Majkowska, Lilianna

2012-01-01

307

Gestational diabetes mellitus decreases placental uptake of long-chain polyunsaturated fatty acids: involvement of long-chain acyl-CoA synthetase.  

PubMed

The long-chain polyunsaturated fatty acids (LC-PUFAs) arachidonic (AA) and docosahexaenoic (DHA) acids are essential for fetal development. Gestational diabetes mellitus (GDM) is a pregnancy disorder associated with perinatal and lifelong risk complications for both the mother and the newborn. Our aim was to investigate the influence of GDM, and some of its associated conditions, upon the placental uptake of AA and DHA. Uptake of (14)C-AA and (14)C-DHA by human trophoblasts obtained from normal pregnancies (NTB cells) was mediated by both saturable (for lower substrate concentrations) and non-saturable (for higher substrate concentrations) mechanisms. Uptake of both fatty acids was inhibited by other LC-PUFAs and, markedly, by the long-chain acyl-CoA synthetase (ACSL) inhibitor, triacsin C. Human trophoblasts obtained from GDM pregnancies (DTB cells) showed a significantly lower (14)C-AA and (14)C-DHA accumulation, through a decrease in both the saturable and the non-saturable components of uptake, which was associated with a decrease in ACSL1 mRNA levels. Uptake of LC-PUFAs by NTB cells increased (by 20-25%) after short-term exposure to TNF-? ((14)C-AA and (14)C-DHA) and insulin ((14)C-DHA). In conclusion, GDM, distinctly from its associated conditions, markedly decreases placental uptake of LC-PUFAs, which probably contributes to the deleterious effects of this disease for the newborn. PMID:23790250

Araújo, João R; Correia-Branco, Ana; Ramalho, Carla; Keating, Elisa; Martel, Fátima

2013-06-18

308

Sleep-Disordered Breathing and Gestational Diabetes Mellitus: A meta-analysis of 9,795 participants enrolled in epidemiological observational studies.  

PubMed

OBJECTIVE Recently, sleep-disordered breathing (SDB) has been reported to be associated with the development of gestational diabetes mellitus (GDM). Accordingly, as this is emergent area of research that has significant clinical relevance, the objective of this meta-analysis is to examine the relationship between SDB with GDM. RESEARCH DESIGN AND METHODS We searched several electronic databases for all of the studies published before January 2013 and reviewed references of published articles. Meta-analytic procedures were used to estimate the unadjusted and BMI-adjusted odds ratios (ORs) using a random effects model. Significant values, weighted effect sizes, and 95% CIs were calculated, and tests of homogeneity of variance were performed. RESULTS Results from nine independent studies with a total of 9,795 pregnant women showed that SDB was significantly associated with an increased risk of GDM. Women with SDB had a more than threefold increased risk of GDM, with a pooled BMI-adjusted OR 3.06 (95% CI 1.89-4.96). CONCLUSIONS These findings demonstrate a significant association between SDB and GDM that is evident even after considered confounding by obesity. This meta-analysis indicates a need to evaluate the role of early recognition and treatment of SDB early during pregnancy. PMID:24065843

Luque-Fernandez, Miguel Angel; Bain, Paul A; Gelaye, Bizu; Redline, Susan; Williams, Michelle A

2013-10-01

309

Obesity and Blood Pressure in 17-Year-Old Offspring of Mothers with Gestational Diabetes: Insights from the Jerusalem Perinatal Study  

PubMed Central

Objective. Gestational diabetes mellitus (GDM) influences fetal development and offspring's metabolic risk. We evaluated this association in 17-year-old offspring adjusting for birth weight (BW) and prepregnancy maternal BMI (mBMI). Study Design. The JPS birth cohort contains extensive data on 92,408 births from 1964 to 1976. Offspring's BMI and blood pressure (BP) were obtained from military records. For a subcohort born between 1974 and 1976, prepregnancy mBMI was available. Offspring were classified as born to mothers with GDM (n = 293) or born to mothers without recorded GDM (n = 59,499). Results. GDM offspring had higher mean BMI and systolic and diastolic BP compared to no-recorded-GDM offspring. After adjusting for BW, GDM remained significantly associated with offspring BMI and diastolic BP (? = 1.169 and 1.520, resp.). In the subcohort, when prepregnancy mBMI was entered to the models, it markedly attenuated the associations with GDM. Conclusions. Maternal characteristics have long-term effects on cardiometabolic outcomes of their offspring aged 17 years.

Avgil Tsadok, Meytal; Friedlander, Yechiel; Paltiel, Ora; Manor, Orly; Meiner, Vardiella; Hochner, Hagit; Sagy, Yael; Sharon, Nir; Yazdgerdi, Shoshanah; Siscovick, David; Elchalal, Uriel

2011-01-01

310

Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial  

PubMed Central

Background Gestational Diabetes Mellitus (GDM) increases risks for type 2 diabetes and weight management is recommended to reduce the risk. Conventional dietary recommendations (energy-restricted, low fat) have limited success in women with previous GDM. The effect of lowering Glycaemic Index (GI) in managing glycaemic variables and body weight in women post-GDM is unknown. Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education, in the management of glucose tolerance and body weight in Asian women with previous GDM. Method Seventy seven Asian, non-diabetic women with previous GDM, between 20- 40y were randomised into Conventional healthy dietary recommendation (CHDR) and low GI (LGI) groups. CHDR received conventional dietary recommendations only (energy restricted, low in fat and refined sugars, high-fibre). LGI group received advice on lowering GI in addition. Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test (2HPP) were measured at baseline and 6 months after intervention. Anthropometry and dietary intake were assessed at baseline, three and six months after intervention. The study is registered at the Malaysian National Medical Research Register (NMRR) with Research ID: 5183. Results After 6 months, significant reductions in body weight, BMI and waist-to-hip ratio were observed only in LGI group (P<0.05). Mean BMI changes were significantly different between groups (LGI vs. CHDR: -0.6 vs. 0 kg/m2, P= 0.03). More subjects achieved weight loss ?5% in LGI compared to CHDR group (33% vs. 8%, P=0.01). Changes in 2HPP were significantly different between groups (LGI vs. CHDR: median (IQR): -0.2(2.8) vs. +0.8 (2.0) mmol/L, P=0.025). Subjects with baseline fasting insulin?2 ?IU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group (?1.9±0.42 vs. +1.31±1.4 mmol/L, P<0.001). After 6 months, LGI group diets showed significantly lower GI (57±5 vs. 64±6, P<0.001), GL (122±33 vs. 142±35, P=0.04) and higher fibre content (17±4 vs.13±4 g, P<0.001). Caloric intakes were comparable between groups. Conclusion In women post-GDM, lowering GI of healthy diets resulted in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription.

2013-01-01

311

The Efficacy and Safety of a High Dose of Vitamin D in Mothers with Gestational Diabetes Mellitus: A Randomized Controlled Clinical Trial  

PubMed Central

Background: During pregnancy and lactation outstanding changes occur in mother’s vitamin D metabolism. This study was carried out to evaluate the efficacy of 300,000 IU vitamin D given intramuscularly on body status in new cases of gestational diabetes mellitus (GDM). Methods: This is a randomized clinical trial with the follow-up period of 3 months. Totally 45 participants were randomly divided into intervention group (IG) and control group (CG). The IG received an IM injection of 300,000 IU of vitamin D, whereas CG did not. The glycosylated hemoglobin A1C (HBA1C), serum 25-OH-D, parathyroid hormone (PTH), serum calcium and phosphorus were measured. Results: Forty five patients including 24 with the mean age of 30.7±6.2 years in the IG and 21 with the mean age of 29.5±4.0 years in the CG participated in the study. The median concentration of serum 25(OH)D3 in the IG was to 62.10 nmol/l after the intervention, showing an increase of around 158%, compared to before intervention (24.25 nmol/l) whereas the CG showed a decrease of around 4.5%. Of the patients, 79.2% of IG and 81.9% of CG suffered to some degree from vitamin D deficiency. These figures were 4.2% and 71.4% for the IG and CG, respectively after the intervention. For the IG, the PTH was significantly lower and Ca was significantly higher after the intervention. The serum Phosphorus before and after the intervention in each group or between the two groups was not significant. Conclusions: The single 300,000 IM dose of vitamin D is regarded as an effective and safe to promptly improve vitamin D status in GDM. Trial Registration Number: IRCT138902113840N1

Hosseinzadeh-Shamsi-Anar, Mahdieh; Mozaffari-Khosravi, Hassan; Salami, Maryam-Alsadat; Hadinedoushan, Hossein; Mozayan, Mohammad Reza

2012-01-01

312

Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial.  

PubMed

Although gestational diabetes mellitus (GDM) is associated with an increased risk of maternal and neonatal morbidity, there is no consensus as to the optimal approach of nutritional management in these patients. The present study was designed to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM. The present randomised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24-28 weeks of gestation. Subjects were randomly assigned to consume either the control diet (n 17) or the DASH eating pattern (n 17) for 4 weeks. The control diet was designed to contain 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The macronutrient composition of the DASH diet was similar to the control diet; however, the DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg Na/d. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose, glycated Hb (HbA1c) and lipid profiles. Participants underwent a 3 h oral glucose tolerance tests and blood samples were collected at 60, 120 and 180 min to measure plasma glucose levels. Adherence to the DASH eating pattern, compared with the control diet, resulted in improved glucose tolerance such that plasma glucose levels reduced at 60 (21·86 v. 20·45 mmol/l, Pgroup = 0·02), 120 (22·3 v. 0·2 mmol/l, Pgroup = 0·001) and 180 min (21·7 v. 0·22 mmol/l, Pgroup = 0·002) after the glucose load. Decreased HbA1c levels (20·2 v. 0·05 %, Pgroup = 0·001) was also seen in the DASH group compared with the control group. Mean changes for serum total (20·42 v. 0·31 mmol/l, Pgroup = 0·01) and LDL-cholesterol (20·47 v. 0·22 mmol/l, Pgroup = 0·005), TAG (20·17 v. 0·34 mmol/l, Pgroup = 0·01) and total:HDL-cholesterol ratio (20·6 (SD 0·9) v. 0·3 (SD 0·8), Pgroup = 0·008) were significantly different between the two diets. Additionally, consumption of the DASH diet favourably influenced systolic blood pressure (22·6 v. 1·7 mmHg, Pgroup = 0·001). Mean changes of fasting plasma glucose (20·29 v. 0·15 mmol/l, Pgroup = 0·09) were nonsignificant comparing the DASH diet with the control diet. In conclusion, consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM resulted in beneficial effects on glucose tolerance and lipid profiles compared with the control diet. PMID:23148885

Asemi, Zatollah; Tabassi, Zohreh; Samimi, Mansooreh; Fahiminejad, Taherh; Esmaillzadeh, Ahmad

2012-11-13

313

Learned helplessness: The result of uncontrollable reinforcements or uncontrollable aversive stimuli?  

Microsoft Academic Search

To determine whether learned helplessness results from exposure to uncontrollable reinforcements or exposure to uncontrollable aversive outcomes, 100 male and female university students, were assigned to 1 of 4 pretreatments involving discrimination problems: (a) soluble, in which each S was presented soluble problems and response-contingent \\

James S. Benson; Kevin J. Kennelly

1976-01-01

314

Gestational assessment assessed  

Microsoft Academic Search

AIMSTo review the accuracy with which obstetric information on gestation is recorded in the neonatal records; and the reliability of the methods used for assessing gestational age after birth.METHODSService information on all babies born in 1989, and research information on all babies of 32 weeks gestation, and senior staff looked at 105 babies of < 30 weeks gestation.RESULTSThe best techniques

Unni Wariyar; Win Tin; Edmund Hey

1997-01-01

315

National Diabetes Fact Sheet, 2011  

MedlinePLUS

... Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian ...

316

Soft constraint problems with uncontrollable variables  

Microsoft Academic Search

Preferences and uncertainty are common in many real-life problems. In this article, we consider preferences modelled via soft constraints that allow for the representation of quantitative preferences. Moreover, we consider uncertainty modelled via uncontrollable variables, that is, variables whose value cannot be decided by us. We also assume that some information is provided for such variables in the form of

Maria Silvia Pini; Francesca Rossi; Kristen Brent Venable

2010-01-01

317

Management of uncontrolled hazardous waste sites  

SciTech Connect

This book is a compilation of papers presented at a conference on the management of uncontrolled hazardous waste sites. Papers were presented in the following topics: federal and state programs; sampling and monitoring; leaking tanks; in-situ treatment; site remediation; banner technology; storage/disposal; endangerment assessment; risk assessment techniques; and research and development.

Not Available

1985-01-01

318

Uncontrollable computational growth in theoretical physics  

Microsoft Academic Search

Some new results in the theory of synchronous parallel computation indicate there may be fundamentally unavoidable limitations to computing in certain kinds of large computational problems arising naturally in science and engineering. These limitations are in the nature of uncontrolled growth (discontinuous jumps) in computation times under fixed programming schemes, and arise for computations allowing arbitrary (uniform) inputs overFn for

R. Cuykendall

1985-01-01

319

IHS Introduction to Type 2 Diabetes. A Guide for Health Care Providers (Revised).  

National Technical Information Service (NTIS)

Contents: What is Type 2 Diabetes; The Cycle of Type 2 Diabetes; Type 1 vs. Type 2 Diabetes; Risk Factors for Type 2 Diabetes in American Indians; Diagnosing Diabetes; Diagnostic Criteria for Diabetes Mellitus, Impaired Glucose Metabolism, and Gestational...

1998-01-01

320

Pre-Diabetes  

MedlinePLUS

... blood pressure A history of gestational diabetes Being African-American, American Indian, Asian-American, Pacific Islander or Hispanic ... blood sugar levels will probably eventually rise to diabetic levels. Once this happens, medication is usually required ...

321

Breastfeeding and Diabetes  

Microsoft Academic Search

\\u000a As diabetes becomes more prevalent in younger women, diabetes and maternal-child health issues such as breastfeeding coexist\\u000a with increasing frequency in clinical practice. Women with diabetes of any kind including type 1 diabetes (DM1), type 2 diabetes\\u000a (DM2) or gestational diabetes (GDM) should be strongly encouraged to breastfeed because of the maternal and pediatric benefits\\u000a specific to obesity and diabetes

Julie Scott Taylor; Melissa Nothnagle; Susanna R. Magee

322

Maternal Moderate Physical Training during Pregnancy Attenuates the Effects of a Low-Protein Diet on the Impaired Secretion of Insulin in Rats: Potential Role for Compensation of Insulin Resistance and Preventing Gestational Diabetes Mellitus  

PubMed Central

The effects of pregestational and gestational low-to-moderate physical training on insulin secretion in undernourished mothers were evaluated. Virgin female Wistar rats were divided into four groups as follows: control (C, n = 5); trained (T, n = 5); low-protein diet (LP, n = 5); trained with a low-protein diet (T + LP, n = 5). Trained rats ran on a treadmill over a period of 4 weeks before mate (5 days week?1 and 60?min day?1, at 65% of VO2max). At pregnancy, the intensity and duration of the exercise were reduced. Low-protein groups were provided with an 8% casein diet, and controls were provided with a 17% casein diet. At third day after delivery, mothers and pups were killed and islets were isolated by collagenase digestion of pancreas and incubated for a further 1?h with medium containing 5.6 or 16.7?mM glucose. T mothers showed increased insulin secretion by isolated islets incubated with 16.7?mM glucose, whereas LP group showed reduced secretion of insulin by isolated islets when compared with both C and LP + T groups. Physical training before and during pregnancy attenuated the effects of a low-protein diet on the secretion of insulin, suggesting a potential role for compensation of insulin resistance and preventing gestational diabetes mellitus.

Leandro, Carol Gois; Fidalgo, Marco; Bento-Santos, Adriano; Falcao-Tebas, Filippe; Vasconcelos, Diogo; Manhaes-de-Castro, Raul; Carpinelli, Angelo Rafael; Hirabara, Sandro Massao; Curi, Rui

2012-01-01

323

CFD modeling of Dalmarnock uncontrolled fire test  

NASA Astrophysics Data System (ADS)

The study describes a CFD based modeling of a fire in multi-storey apartments building. The model parameters are taken from a fire experiment with uncontrolled ventilation conditions. The aim of the current work is to describe some features and difficulties of fire CFD modeling in close compartments. The instrument used for CFD modeling was Fire Dynamic Simulator. The analysis is made in terms of fire development in an apartment and influence of wind velocity changes on temperature fields

Mijorski, Sergey; Stankov, Peter

2012-06-01

324

The poorly explored impact of uncontrolled asthma.  

PubMed

The goal of asthma management is to achieve disease control; however, despite the availability of effective and safe medications, for many patients asthma remains uncontrolled. One reason for this is the fear of long-term side effects from the regular use of inhaled corticosteroids (ICSs). Adverse effects of poorly controlled asthma (for example, obesity, pneumonia, and risks to the fetus) can be perceived as side effects of ICSs. Poorly controlled asthma adversely affects children's cardiovascular fitness, while children with well-controlled asthma perform at the same level as their peers. Children with uncontrolled asthma also have a higher frequency of obesity than children with controlled asthma. Stress can affect asthma control, and children with poorly controlled asthma are more likely to have learning disabilities compared with those with good control. In adults, focused attention and concentration are negatively affected in patients with untreated asthma, and patients with asthma are at greater risk for depression. Also, poorly controlled asthma increases the risks of severe asthma exacerbations following upper respiratory and pneumococcal pulmonary infections. ICSs used to improve asthma control have been demonstrated to improve all of these outcomes. Lastly, the risks of uncontrolled asthma during pregnancy are substantially greater than the risks of recommended asthma medications. Treatments to maintain asthma control are the best approach to optimize maternal and fetal health in the pregnancies of women with asthma. The maintenance of asthma control has significant advantages to patients and greatly outweighs the potential risks of treatment side effects. PMID:23381316

O'Byrne, Paul M; Pedersen, Søren; Schatz, Michael; Thoren, Anders; Ekholm, Ella; Carlsson, Lars-Göran; Busse, William W

2013-02-01

325

Diabetes in pregnancy  

Microsoft Academic Search

Diabetes is the most common medical condition to complicate pregnancy and includes pregestational type 1 and type 2 diabetes and gestational diabetes, defined as glucose intolerance first diagnosed during pregnancy. Risks for the fetus include malformation, spontaneous abortion, stillbirth, neonatal death, macrosomia and intrauterine growth retardation. Risks for the mother include severe hypoglycaemia, diabetic ketoacidosis, progression of eye or renal

Rosemary Temple

2006-01-01

326

Diabetes Epidemic Among Hispanics/Latinos  

MedlinePLUS

... is called acanthosis nigricans.) ? Gestational diabetes develops during pregnancy. Women who have had gestational diabetes have a 40 to 60 percent chance of developing diabetes, mostly type 2, in the next five to 10 years. HOW MANY HISPANICS/LATINOS HAVE DIABETES? ? 10.4 percent of Hispanics/ ...

327

Diabetes  

NSDL National Science Digital Library

Diabetes, in a variety of forms, affects many Americans and is the 4th leading cause of death by disease in the US. Diabetes is fundamentally a disease in which the body cannot produce or effectively use a critical hormone called insulin. Untreated / unmanaged diabetes can lead to blindness, kidney failure, heart disease, loss of limbs and stroke.

Dr. Leslie Nader (MSMR)

1993-04-14

328

Toward universal criteria for gestational diabetes: Relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations  

Microsoft Academic Search

OBJECTIVES: Replacement of the two-step, 100 gm, 3-hour National Diabetes Data Group procedure by the one-step, 75 gm, 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy. The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood.

Peter A. Weiss; Martin Haeusler; Franz Kainer; Peter Pürstner; Josef Haas

1998-01-01

329

Maternal diabetes mellitus and infant malformations  

Microsoft Academic Search

OBJECTIVE:To investigate the effects of pregestational, as opposed to gestational, diabetes on infant malformations.METHODS:All women delivering infants at Parkland Hospital between January 1, 1991, and December 31, 2000, were ascertained. Screening for gestational diabetes was methodically employed throughout the study period using National Diabetes Data Group criteria for diagnosis of pregestational and gestational diabetes. Standardized definitions of major infant malformations

Jeanne S Sheffield; Erin L Butler-Koster; Brian M Casey; Donald D McIntire; Kenneth J Leveno

2002-01-01

330

Capture of uncontrolled satellites - A flight demonstration  

NASA Astrophysics Data System (ADS)

NASA is presently exploring concepts, systems, and devices for capturing uncontrolled or non-operational satellites. Understanding of this type capture involves development of requirements and options, analyses of approaches, and extensive ground simulations. The verification of an approach is expected to require flight demonstrations of the concepts and hardware to assure confidence in application. This paper addresses a flight demonstration involving the Shuttle, an Orbital Maneuvering Vehicle (OMV), a capture mechanism, and a target vehicle capable of providing characteristic motion. A mission scenario is projected which demonstrates a capture concept, mission sequencing, capture vehicle potential, and overall capture possibilities with man-in-the-loop control. The proposed demonstration is considered a stepping stone to more demanding capture requirements. On-orbit activities are deliberately constrained to existing technology and projected systems and hardware capability for the year 1990.

Lenox, H. M.

331

Diabetes in Pregnancy  

Microsoft Academic Search

A review of present practices in the assessment and treatment of diabetes during pregnancy is presented, including preconception\\u000a counseling, insulin therapy, nutrition and exercise therapy of patients with pre-existing diabetes, care of patients with\\u000a gestational diabetes, and post-partum care for infants and mothers of both conditions.

Elizabeth S. Halprin

332

Diabetes  

MedlinePLUS

... Frequent or recurring skin, gum, bladder or vaginal yeast infections People who have type 2 diabetes may ... in the armpits, high blood pressure, cholesterol problems, yeast infections and skipped or absent periods in teen ...

333

Ethnic variation in the activity of lipid desaturases and their relationships with cardiovascular risk factors in control women and an at-risk group with previous gestational diabetes mellitus: a cross-sectional study  

PubMed Central

Background Lipid desaturase enzymes mediate the metabolism of fatty acids to long chain polyunsaturated fatty acids and their activities are related to metabolic risk factors for Type 2 diabetes (T2DM) and coronary heart disease (CHD). There are marked ethnic differences in risks of CHD and T2DM but little is known about ethnic differences in desaturase activities. Methods Samples from a study of CVD risk in women with previous gestational diabetes were analysed for percentage fatty acids in plasma free fatty acid, triglyceride, cholesterol ester and phospholipid pools for 89 white European, 53 African Caribbean and 56 Asian Indian women. The fatty acid desaturase activities, stearoyl-CoA desaturase (SCD, calculated separately for C16 and C18 fatty acids), delta 6 desaturase (D6D) and delta 5 desaturase (D5D) were estimated from precursor-to-product ratios and their relationships with adiposity, blood pressure, cholesterol, triglycerides, HDL cholesterol and insulin sensitivity explored. Ethnic differences in desaturase activities independent of ethnic variation in risk factor correlates of desaturase activities were then identified. Results There was significant ethnic variation in age, BMI, waist circumference, blood pressure, serum triglycerides and HDL cholesterol concentrations and insulin resistance. Desaturase activities showed significant correlations, independent of ethnicity, with BMI, waist circumference, triglycerides and HDL cholesterol. Independent of ethnic variation in BMI, waist circumference, triglycerides and HDL cholesterol, SCD-16 activity, calculated from each of the four lipid pools measured, was 18–35 percent higher in white Europeans than in African Caribbeans or Asian Indians (all p?

2013-01-01

334

Diabetes and Cancer  

MedlinePLUS

Prevention Lower Your Risk Small Steps for Your Health Healthy Eating Overweight All About Cholesterol Physical Activity High Blood Pressure High Blood Glucose Smoking Gestational Diabetes Age, Race, Gender & Family ...

335

Gestational age in twins.  

PubMed Central

Dubowitz et al. have offered a scoring system for estimating the gestational age of newborn babies. If the system is applied to twin pairs, the heavier twin is generally estimated to have a greater gestational age than the lighter one. Previously this has been interpreted as a flaw in the scoring system. However, it may well be that in some twin pairs the gestational ages are slightly different and that therefore, the heavier twin would be expected to have a greater gestational age. Such cases would arise through superfecundation (the formation of two zygotes from different coitions). Superfecundation can be proved only in rare case (those with two fathers). It can be argued that the rarity of such cases is accounted for by the rarity with which women expose themselves to the risk of bearing such twins (and by the improbability of detection), rather than by the rarity of superfecundation. It is inferred that superfecundation by the same man is relatively common and that therefore dizygotic twins quite often have different gestational ages. The scoring system of Dubowitz can be tested for bias by submitting monozygotic pairs to it: the association between weight and estimated gestational age should be absent in such pairs. If the system proves free of such bias, then a finding first reported here will assume some interest: it is that in opposite-sexed twin pairs, the male is significantly more often assessed as having the greater gestational age. It is suggested that this finding should be provisionally accepted as evidence for the hyopthesis that male zygotes are formed earlier than females.

James, W H

1980-01-01

336

METHODOLOGY TO INVENTORY, CLASSIFY, AND PRIORITIZE UNCONTROLLED WASTE DISPOSAL SITES  

EPA Science Inventory

A comprehensive method to inventory uncontrolled waste disposal sites integrates all available historic, engineering, geologic, land use, water supply, and public agency or private company records in order to develop a complete and accurate site profile. Detailed information on s...

337

EMISSIONS OF PCDD/F FROM UNCONTROLLED, DOMESTIC WASTE BURNING  

EPA Science Inventory

Emissions of polychlorinated bibenzodioxin and dibenzofuran (PCDD/F) result from inefficiencies of combustion processes, most typically waste combustion. Uncontrolled combustion, such as occurs during so-called "backyard burning" of domestic waste, may therefore produce optimal ...

338

14 CFR 31.19 - Performance: Uncontrolled descent.  

Code of Federal Regulations, 2013 CFR

...be determined for the most critical uncontrolled descent that can result from any single failure of the heater assembly, fuel cell system, gas value system, or maneuvering vent system, or from any single tear in the balloon envelope between...

2013-01-01

339

COSTS OF REMEDIAL RESPONSE ACTIONS AT UNCONTROLLED HAZARDOUS WASTE SITES  

EPA Science Inventory

The primary purpose of this study was to update conceptual design cost estimates for remedial action unit operations portrayed in earlier reports. Thirty-five remedial action unit operations conceptual designs, addressing uncontrolled landfill or impoundment disposal sites, were ...

340

Diabetes  

NSDL National Science Digital Library

This booklet summarizes what health professionals know about type 2 diabetes what it is, who is at risk for it, how it can be prevented, and how it is treated. It describes how researchers study the disease and what individuals can do to help reduce the rising number of diabetes cases now affecting millions of children and adults around the country.The Science Inside e-book series is ntended to be a bridge between the consumer health brochure and the scientific paper, the booklets in this series focus on the science that is inside of, or behind, the disease its cause, its possible cure, its treatment, promising research, and so on. These booklets are designed to appeal to people who have not had the opportunity to study the science and to understand why they may have been given some of the advice that they have been given through some of the more consumer-oriented materials.

American Association for the Advancement of Science (;)

2003-01-01

341

Diabetes  

NSDL National Science Digital Library

This booklet summarizes what health professionals know about type 2 diabetes what it is, who is at risk for it, how it can be prevented, and how it is treated. It describes how researchers study the disease and what individuals can do to help reduce the rising number of diabetes cases now affecting millions of children and adults around the country.The Science Inside e-book series is intended to be a bridge between the consumer health brochure and the scientific paper, the booklets in this series focus on the science that is inside of, or behind, the disease its cause, its possible cure, its treatment, promising research, and so on. These booklets are designed to appeal to people who have not had the opportunity to study the science and to understand why they may have been given some of the advice that they have been given through some of the more consumer-oriented materials.

American Association for the Advancement of Science (American Association for the Advancement of Science;)

2006-01-01

342

Gestational Diabetes: A Guide for Pregnant Women  

MedlinePLUS

... Hopkins University Evidence-based Practice Center. The review was updated in the journal Obstetrics & Gynecology in 2009. The Agency for Healthcare Research and Quality (AHRQ) created the Eisenberg Center at Oregon Health & Science University ...

343

Predictors of uncontrolled hypertension in the Stroke Belt.  

PubMed

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN. PMID:23889718

Dave, Gaurav J; Bibeau, Daniel L; Schulz, Mark R; Aronson, Robert E; Ivanov, Louise L; Black, Adina; Spann, Lapronda

2013-05-09

344

Spontaneous triplet, tubal ectopic gestation.  

PubMed Central

Only six cases of spontaneous, unilateral, triplet ectopic gestations have previously been reported. We now present a seventh case. The patient's prior obstetrical history was significant for a term stillbirth and a term cesarean section for breech. Quantitative betahCG was normal for gestational age; however, the increased trophoblastic mass of an inappropriately implanted multiple gestation may produce sufficient betahCG to mimic an intrauterine singleton gestation. Resolution was achieved via salpingostomy. This case is significant for being spontaneously conceived and not the result of assisted reproductive technologies. Furthermore, this case supports an association between prior cesarean section and ectopic gestation. Images Figure 1

Nwanodi, Oroma; Berry, Robert

2006-01-01

345

Appraisal of uncontrolled flowing artesian wells in Florida  

USGS Publications Warehouse

An estimated 15,000 uncontrolled flowing wells, many discharging water of poor quality are wastefully discharging about 790 million gallons per day by surface and internal flow. Internal flow in principal problem areas have been identified in Brevard, Charlotte, Clay, De Soto, Duval, Flagler, Glades, Hendry, Hillsborough, Lee, Manatee, Martin, Nassau, and Sarasota Counties. In many areas, uncontrolled discharge over the years has caused a decline in the potentiometric surface locally and regionally, and a deterioration of the potable water aquifers. Programs for control of flowing wells are being carried on by State, county, municipal, or Federal agencies in 21 countries. (Woodard-USGS)

Healy, Henry G.

1978-01-01

346

Conditions that Influence Drivers' Yielding Behavior for Uncontrolled Crossings  

ERIC Educational Resources Information Center

|Pedestrians with visual impairments need to cross streets where traffic signals and traffic signage are not present. This study examined the influences of several interventions, including a pedestrian's use of a mobility cane, on the behavior of drivers when they were expected to yield to a pedestrian crossing at an uncontrolled crossing.…

Bourquin, Eugene; Emerson, Robert Wall; Sauerburger, Dona

2011-01-01

347

A paradox in depression: Uncontrollability and self-blame  

Microsoft Academic Search

Traditionally, clinical descriptions of the cognitions of depressives have centered on the features of helplessness and self-blame. The view of the depressive as helpless and as believing in the uncontrollability of outcomes is embodied in the learned helplessness model of depression. A. T. Beck's (1967) cognitive theory of depression regards self-blame as a primary feature of the disorder. It is

Lyn Y. Abramson; Harold A. Sackheim

1977-01-01

348

Unpredictable and Uncontrollable Events: A New Perspective on Experimental Neurosis  

ERIC Educational Resources Information Center

|Recent work has shown that unpredictable and/or uncontrollable events can produce a variety of cognitive, affective, and somatic disturbances to the organism. These disturbances are compared to and found to be quite similar to the symptoms of the classic cases of experimental neurosis described by Pavlov, Gantt, Liddell, Masserman, and Wolpe.…

Kihlstrom, John F.; Mineka, Susan

1978-01-01

349

Sedation for Uncontrolled Symptoms in a South African Hospice  

Microsoft Academic Search

The need to sedate terminally ill patients for uncontrolled symptoms has been previously documented in a few reports. A retrospective consecutive chart review was undertaken at a hospice in Cape Town, South Africa, to develop an understanding of the local experience and assess the potential for improved patient management. Twenty-three of seventy-six (30%) patients received sedating therapies: twenty patients for

Robin L. Fainsinger; Willie Landman; Mark Hoskings; Eduardo Bruera

1998-01-01

350

Further Results on Computing the Distance to Uncontrollability via LMIs  

Microsoft Academic Search

This paper concerns the computation of the distance to uncontrollability (DTUC) of a given controllable pair A isin Cntimesn and B isin Cntimesm. This problem can be regarded as a special case of the structured singular value computation problems and motivated from this fact, in our preceding work, we derived an semidefinite program (SDP) to compute the lower bounds of

Yoshio Ebihara; Tomomichi Hagiwara

2007-01-01

351

APPROACHES FOR REMEDIATION OF UNCONTROLLED WOOD PRESERVING SITES  

EPA Science Inventory

This document provides an overview of remediation of uncontrolled wood preserving sites. It is, in part, a distillation of discussions that took place at a Forum on Wood Preserving Waste that was held in San Francisco, California, in October 1988. Information from this workshop h...

352

Conditions that Influence Drivers' Yielding Behavior for Uncontrolled Crossings  

ERIC Educational Resources Information Center

Pedestrians with visual impairments need to cross streets where traffic signals and traffic signage are not present. This study examined the influences of several interventions, including a pedestrian's use of a mobility cane, on the behavior of drivers when they were expected to yield to a pedestrian crossing at an uncontrolled crossing.…

Bourquin, Eugene; Emerson, Robert Wall; Sauerburger, Dona

2011-01-01

353

Prevalence of Uncontrolled Hypertension in Patients With Fabry Disease  

Microsoft Academic Search

Background: Fabry disease is a rare X-linked disease arising from deficiency of ?-galactosidase A. It results in early death related to renal, cardiac, and cerebrovascular disease, which are also important outcomes in patients with elevated blood pressure (BP). The prevalence of uncontrolled hypertension, as well as the effect of enzyme replacement therapy on BP, in patients with Fabry disease is

Julia Kleinert; François Dehout; Andreas Schwarting; Abelardo García de Lorenzo; Roberta Ricci; Christoph Kampmann; Michael Beck; Uma Ramaswami; Ales Linhart; Andreas Gal; Gunnar Houge; Urs Widmer; Atul Mehta; Gere Sunder-Plassmann

2006-01-01

354

78 FR 14561 - Notice of Diabetes Mellitus Interagency Coordinating Committee Meeting  

Federal Register 2010, 2011, 2012, 2013

...Institutes of Health Notice of Diabetes Mellitus Interagency Coordinating Committee Meeting SUMMARY: The Diabetes Mellitus Interagency Coordinating Committee...Initiatives to Address Gestational Diabetes Mellitus.'' The meeting is open...

2013-03-06

355

Programming of Adult Cardiovascular Disease following Exposure to Late-Gestation Hyperglycemia  

Microsoft Academic Search

Background: In utero exposure to hyperglycemia is becoming increasingly prevalent as the number of women entering pregnancy with type II diabetes, or developing gestational diabetes, increases. Both animal studies and epidemiologic investigations have found cardiovascular abnormalities in adult offspring of hyperglycemic mothers (OHM). Objective: We hypothesized that adult OHM would have abnormal cardiac function in vivo and increased susceptibility to

Melissa Agoudemos; Benjamin E. Reinking; Stacia L. Koppenhafer; Jeffrey L. Segar; Thomas D. Scholz

2011-01-01

356

Uncontrollable prurigo nodularis effectively treated by roxithromycin and tranilast.  

PubMed

Treatment of prurigo nodularis (PN) is often very difficult even with strong corticosteroid dressing and other available means. Macrolide roxithromycin (RXM) is used in consideration of its immunosuppressive effects in treating several skin disorders. Tranilast (N-(3,4-dimethoxycinnamoyl) is useful for treating atopic disorders and hypertrophic scars as well, suggesting its capacity to inhibit fibroblast proliferation. More adequate and effective therapy for this disorder has been requested. We report 3 cases of uncontrollable PN treated with 300 mg/day roxithromycin and 200 mg/day tranilast. Complete and/or remarkable regression of PN was observed on treatment with roxithromycin and tranilast in combination within 4 to 6 months. The 2 agents in combination can be used effectively for the treatment of uncontrollable PN. PMID:16673805

Horiuchi, Yasuhiro; Bae, Sangjae; Katayama, Ichiro

2006-04-01

357

Diabetes and Pregnancy - Multiple Languages: MedlinePlus  

MedlinePLUS

... Chinese - Simplified) PDF Chinese Community Health Resource Center Sample Meal Plan for Gestational Diabetic Mothers English ????????? - ???? (Chinese - ... Chinese - Traditional) PDF Chinese Community Health Resource Center Sample Meal Plan for ... Diabetics English ????????? - ???? (Chinese - Traditional) ...

358

Uncontrolled withdrawal of a control rod without scram  

Microsoft Academic Search

In the present work the thermal-hydraulics of reactivity-induced transients in low enriched uranium (LEU) core of a typical material test research reactor (MTR) are analyzed using the previous program developed by Khater et al. The analysis was done for uncontrolled withdrawal of a control rod with scram-disabled conditions. Initiating reactivity events with and without the influence of reactivity efficiency curve

Talal Abou-EL-Maaty

2008-01-01

359

A teenager with uncontrolled hypertension: a case report  

PubMed Central

Background Takayasu Arteritis is a vasculitis occurring mostly in young females which may present in diverse ways. Here we report a teenager with Takayasu Arteritis who presented with uncontrolled hypertension. This case depicts an atypical presentation of this disease where the girl visited many physicians for controlling the level of hypertension and put a diagnostic dilemma about the underlying etiology of young hypertension. Case presentation A 13 year old girl presented with epistaxis, persistent headache and uncontrolled hypertension. Her clinical examination revealed normal radial, very feeble femoral and absent other lower limb pulses. There was a blood pressure discrepancy of 50/40 mm of Hg between two arms. There were bruits over multiple areas including the abdominal aorta. She had features of left ventricular hypertrophy. Her Arch aortogram showed hugely dilated arch of aorta which became abruptly normal just after origin of left subclavian artery. There was ostio-proximal stenosis of right bracheocephalic artery, left common carotid and left subclavian artery with post stenotic dilatation of all the vessels. Abdominal aortogram revealed critical stenosis of abdominal aorta above the origin of renal arteries with a pressure gradient of 80/11 mm of Hg. Conclusion Takayasu’s Arteritis should also be kept in mind while searching for the cause of uncontrolled hypertension in the young age group.

2012-01-01

360

Small for Gestational Age (SGA)  

MedlinePLUS

... Mellitus in Children(DM) Hereditary Metabolic Disorders Hereditary Periodic Fever Syndromes Childhood Cancers Learning and Developmental Disorders ... Gestational Age (LGA) Audio Figures Photographs Pronunciations Sidebar Tables Videos Copyright © 2010-2013 Merck Sharp & Dohme Corp., ...

361

Physical Activity and Risk of Small-for-Gestational-Age Birth Among Predominantly Puerto Rican Women  

Microsoft Academic Search

To estimate the association between multiple domains of physical activity and risk of small-for-gestational-age (SGA) birth.\\u000a We utilized data from 1,040 participants in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of predominantly\\u000a Puerto Rican prenatal care patients in Massachusetts. Physical activity was assessed by bilingual interviewers using a modified\\u000a version of the Kaiser physical activity survey in early

Audra L. Gollenberg; Penelope Pekow; Elizabeth R. Bertone-Johnson; Patty S. Freedson; Glenn Markenson; Lisa Chasan-Taber

2011-01-01

362

Hypertensive disorders in twin versus singleton gestations  

Microsoft Academic Search

Objective: This study was undertaken to compare rates and severity of gestational hypertension and preeclampsia, as well as perinatal outcomes when these complications develop, between women with twin gestations and those with singleton gestations. Study Design: This was a secondary analysis of prospective data from women with twin (n = 684) and singleton (n = 2946) gestations enrolled in two

Baha M. Sibai; John Hauth; Steve Caritis; Marshall D. Lindheimer; Cora MacPherson; Mark Klebanoff; J. Peter VanDorsten; Mark Landon; Menachem Miodovnik; Richard Paul; Paul Meis; Gary Thurnau; Mitchell Dombrowski; James Roberts; Donald McNellis

2000-01-01

363

Robust Crop and Weed Segmentation under Uncontrolled Outdoor Illumination  

PubMed Central

An image processing algorithm for detecting individual weeds was developed and evaluated. Weed detection processes included were normalized excessive green conversion, statistical threshold value estimation, adaptive image segmentation, median filter, morphological feature calculation and Artificial Neural Network (ANN). The developed algorithm was validated for its ability to identify and detect weeds and crop plants under uncontrolled outdoor illuminations. A machine vision implementing field robot captured field images under outdoor illuminations and the image processing algorithm automatically processed them without manual adjustment. The errors of the algorithm, when processing 666 field images, ranged from 2.1 to 2.9%. The ANN correctly detected 72.6% of crop plants from the identified plants, and considered the rest as weeds. However, the ANN identification rates for crop plants were improved up to 95.1% by addressing the error sources in the algorithm. The developed weed detection and image processing algorithm provides a novel method to identify plants against soil background under the uncontrolled outdoor illuminations, and to differentiate weeds from crop plants. Thus, the proposed new machine vision and processing algorithm may be useful for outdoor applications including plant specific direct applications (PSDA).

Jeon, Hong Y.; Tian, Lei F.; Zhu, Heping

2011-01-01

364

Robust crop and weed segmentation under uncontrolled outdoor illumination.  

PubMed

An image processing algorithm for detecting individual weeds was developed and evaluated. Weed detection processes included were normalized excessive green conversion, statistical threshold value estimation, adaptive image segmentation, median filter, morphological feature calculation and Artificial Neural Network (ANN). The developed algorithm was validated for its ability to identify and detect weeds and crop plants under uncontrolled outdoor illuminations. A machine vision implementing field robot captured field images under outdoor illuminations and the image processing algorithm automatically processed them without manual adjustment. The errors of the algorithm, when processing 666 field images, ranged from 2.1 to 2.9%. The ANN correctly detected 72.6% of crop plants from the identified plants, and considered the rest as weeds. However, the ANN identification rates for crop plants were improved up to 95.1% by addressing the error sources in the algorithm. The developed weed detection and image processing algorithm provides a novel method to identify plants against soil background under the uncontrolled outdoor illuminations, and to differentiate weeds from crop plants. Thus, the proposed new machine vision and processing algorithm may be useful for outdoor applications including plant specific direct applications (PSDA). PMID:22163954

Jeon, Hong Y; Tian, Lei F; Zhu, Heping

2011-06-10

365

The relationship of serum AGE levels in diabetic mothers with adverse fetal outcome  

Microsoft Academic Search

Objective:To investigate changes in serum-advanced glycosylation end product (AGE) levels in gestation diabetic mothers (GDMs) and its relationship with adverse fetal outcome.Study Design:A total of 60 GDMs in mid-gestation and 72 late-gestation GDMs fulfilling the inclusion criteria were recruited. Seventy-two mid-gestation and 80 late-gestation mothers with no pregnancy complications acted as controls. Fasting blood glucose and serum AGE levels were

L Guosheng; S Hongmei; N Chuan; L Haiying; Z Xiaopeng; L Xianqiong

2009-01-01

366

Blood glucose determinations in large for gestational age infants.  

PubMed

Our purpose was to identify factors that may contribute to hypoglycemia in large for gestational age (LGA) infants and subsets of infants for whom blood glucose screening would be clinically helpful. LGA infants of 36 to 42 weeks of gestational age using the Denver criteria were identified from the 1999 through 2001 birth log at Marquette General Hospital, Marquette, Michigan, a rural referral hospital, for a retrospective chart review. Infants of mothers with diabetes were excluded. The impact of maternal factors, intrauterine factors, and birthweight on blood glucose levels was assessed using marginal mixed models, Poisson regression, and receiver operating characteristic curves. We found 457 infant records documented blood glucose levels among the 727 infant records analyzed. The lowest blood glucose levels occurred in the first 90 minutes of life. Blood glucose levels were positively associated with weeks of gestation and breastfeeding. Birthweight did not predict hypoglycemia in any of the multivariable models constructed. Symptoms consistent with hypoglycemia occurred only in boys and were negatively associated with gestational age. Models using prenatal and perinatal factors to predict hypoglycemia or symptomatic hypoglycemia had little clinical value. In this large community-based sample of LGA infants, we found no evidence that higher birthweight increases the risk for hypoglycemia. The clinical usefulness of routine blood glucose monitoring in healthy LGA infants is not supported by this retrospective analysis and needs to be established by prospective studies. PMID:18437641

Van Howe, Robert S; Storms, Michelle R

2008-04-24

367

BeppoSAX equatorial uncontrolled re-entry  

NASA Astrophysics Data System (ADS)

The X-ray astronomy satellite BeppoSAX (Satellite per Astronomia X, "Beppo" in honor of Giuseppe Occhialini), is a project of the Italian Space Agency (ASI) with the participation of the Netherlands Agency for Aerospace Programs (NIVR). BeppoSAX was launched by an Atlas G-Centaur directly into a circular 600 km orbit at 3.9° inclination on April 30, 1996. The satellite is a three axis stabilized spacecraft with a total mass of about 1400 kg and main dimensions in flight configuration of about 2450 mm × 8980 mm × 3650 mm. The current (September 21, 2002) flight altitude is about 435 km and its uncontrolled re-entry is predicted late in 2002, or in 2003, with 26 kg of hydrazine on board that could not be vented or used for controlled re-entry due to the gyro package's total failure. Due to the relatively high mass of BeppoSAX, it must be expected that parts of the satellite will survive the re-entry into the Earth atmosphere. The Italian Space Agency has committed a study to analyse of the destructive phase of the uncontrolled atmospheric re-entry by means of a dedicated European software tool (SCARAB). The expected outputs will be used in order to determine how much of the spacecraft and how many fragments of it will reach the ground on the equatorial earth zone. This paper will address the peculiarities of the spacecraft's initial status, its risks at end of life, and the SCARAB modeling as well as its six dimension flight dynamics re-entry analysis results also in terms of the destruction history tree. Consideration will be made of the ground dispersion and casualty area due to the very restricted equatorial zone impacted.

Portelli, C.; Salotti, L.; Anselmo, L.; Lips, T.; Tramutola, A.

2004-01-01

368

Scope for prevention of diabetes--'focus intrauterine milieu interieur'.  

PubMed

The prevalence of diabetes is increasing globally and India is no exception. The lifestyle modification and drug intervention are likely to delay or postpone the development of overt diabetes in persons diagnosed to have impaired glucose tolerance. This is a post primary prevention strategy. The primary prevention is more important as this effort is likely to reverse or halt the epidemic of disease. Women with Gestational Diabetes Mellitus (GDM) are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly type 2 diabetes, as are their children. Pima Indians have the highest prevalence of diabetes. This is attributed to the children exposed in utero to maternal diabetes. Hence as a policy to identify GDM and its consequences on the infant, a 75 gm Oral Glucose Tolerance Test has been recommended to all Pima Indian women during the 3rd trimester of pregnancy. Ethnically Asian Indian women also have high prevalence of diabetes and the relative risk of developing Gestational Diabetes Mellitus in them is 11.3 times compared to White women. This necessitates universal screening for gestational diabetes during pregnancy in India. Probably the undiagnosed gestational diabetes that has been occurring in the past has resulted in the increased prevalence of diabetes in India. The timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all possibility, India becoming the diabetes capital of the world. PMID:18472512

Seshiah, V; Balaji, V; Balaji, Madhuri S

2008-02-01

369

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria  

Microsoft Academic Search

BACKGROUND: Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories. The study aimed to determine morbidity and mortality pattern amongst infants of diabetic

Peace I Opara; Tamunopriye Jaja; Uche C Onubogu

2010-01-01

370

Uncontrolled hyperglycaemia: a reversible cause of hemichorea-hemiballismus.  

PubMed

Hyperosmolar hyperglycaemic state (HHS) an acute complication of diabetes mellitus, can be associated with neurological involvement ranging from seizures, involuntary movements to reversible focal neurological deficits without any structural lesions. We report a 71-year-old woman, a known case of type 2 diabetes mellitus who presented with the sudden onset of hemichorea-hemiballismus. On investigations she had hyperglycaemia and urinary tract infection. Achievement of euglycemia with insulin therapy resolved the involuntary movements completely. This highlights the fact that HHS is an uncommon but easily treatable cause of recent onset unilateral hemichorea-hemiballismus. PMID:24014327

Bhagwat, Nikhil M; Joshi, Ameya S; Rao, Gururaja; Varthakavi, Premlata K

2013-09-06

371

Increased production of active ghrelin is relevant to hyperphagia in nonobese spontaneously diabetic Torii rats  

Microsoft Academic Search

An abnormal eating behavior is often associated with diabetes mellitus in individuals. In the present study, we investigated the mechanisms underlying the relationship among uncontrolled diabetes, food intake, and the production of ghrelin, an orexigenic hormone, in spontaneous diabetic Torii (SDT) rats. Male SDT rats and age-matched control Sprague-Dawley (SD) rats were housed from 8 to 38 weeks of age.

Hiroharu Mifune; Yoshihiro Nishi; Yuji Tajiri; Taku Masuyama; Hiroshi Hosoda; Kenji Kangawa; Masayasu Kojima

372

Attenuation of landfill leachate at two uncontrolled landfills  

NASA Astrophysics Data System (ADS)

Attenuation characteristics of landfill leachate were examined for two uncontrolled landfills in Korea. The two landfills containing municipal wastes without appropriate bottom liner and leachate treatment system have different landfill age, waste volume, and most importantly different hydrogeologic settings. One landfill (Cheonan landfill) is situated in an open flat area while the other (Wonju landfill) is located in a valley. Variations of various parameters including dissolved organic carbon (DOC), dissolved oxygen (DO), alkalinity, pH, electrical conductivity (EC), redox potential (ORP), ammonia (NH3), nitrate (NO{3/-}), sulfate (SO{4/2-}), and chloride (Cl-) were examined along groundwater flow path. All these parameters were analyzed every month for a year. In the interior of the landfills, typical anaerobic conditions revealed by low DO and NO3 concentrations, negative ORP values, high NH3, alkalinity, and Cl- concentrations were observed. Generally, higher levels of contaminants (DOC, NH3, and Cl-) were detected in the dry season while they were greatly lowered in the wet season. Significantly, large decrease of Cl- concentration in the wet season indicates that the dilution or mixing is one of dominant attenuation mechanisms of leachate. But detailed variation behaviors in the two landfills are different and they were largely dependent on permeability of surface and subsurface layers. The intermediately permeable surface of the landfills receives part of direct rainfall infiltration but most rainwater is lost to fast runoff. The practically impermeable surface of clayey silt (paddy field) at immediately adjacent to the Cheonan landfill boundary prevented direct rainwater infiltration and hence redox condition of the ground waters were largely affected by that of the upper landfill and the less permeable materials beneath the paddy fields prohibited dispersion of the landfill leachate into down gradient area. In the Wonju landfill, there are three different permeability divisions, the landfill region, the sandy open field and the paddy field. Roles of the landfill and paddy regions are very similar to those at the Cheonan. The very permeable sandy field receiving a large amount of rainwater infiltration plays a key role in controlling redox condition of the down gradient area and contaminant migration. This paper reports details of the attenuation and redox conditions of the landfill leachates at the two uncontrolled landfills.

Lee, Jin-Yong; Cheon, Jeong-Yong; Kwon, Hyung-Pyo; Yoon, Hee-Sung; Lee, Seong-Sun; Kim, Jong-Ho; Park, Joung-Ku; Kim, Chang-Gyun

2006-12-01

373

Altered cardiovascular rhythmicity in children born small for gestational age.  

PubMed

Low birth weight is frequently associated with a disproportionately high incidence of cardiovascular disease, diabetes mellitus, and kidney disease in adulthood. Epidemiological studies have identified an inverse association between low birth weight or being small for gestational age and hypertension in adulthood. We hypothesized that children born with low birth weight might have altered circadian and ultradian cardiovascular rhythmicity independent of the prevailing blood pressure level. Twenty-four-hour ambulatory blood pressure and heart rate rhythmicity was prospectively evaluated by Fourier analysis in a cohort of healthy children born with low birth weight and compared with normative pediatric data. Seventy-five children born small for gestational age (mean age, 8.1±2.2 years) and 139 controls matched for age and sex were investigated. In addition to increased 24-hour, daytime, and especially nighttime blood pressure levels (P<0.05), children born small for gestational age exhibited blunted circadian (24-hour) and ultradian (12-, 8-, and 6-hour) blood pressure rhythmicity (P<0.05). In a multivariate analysis including children born with low birth weight and controls, being born with low birth weight independently influenced ultradian blood pressure rhythmicity, whereas in a multivariate analysis including children born with low birth weight only, circadian and ultradian rhythms were independently influenced by catch-up growth, gestational age, and blood pressure level. This study demonstrates blunted circadian and ultradian cardiovascular rhythmicity in prepubertal children born small for gestational age, independent from the presence of arterial hypertension. Circadian and ultradian rhythms may be sensitive indicators for detecting subtle early abnormalities of cardiovascular regulation. PMID:22733461

Wolfenstetter, Ann; Simonetti, Giacomo D; Pöschl, Johannes; Schaefer, Franz; Wühl, Elke

2012-06-25

374

Brain Development, Intelligence and Cognitive Outcome in Children Born Small for Gestational Age  

Microsoft Academic Search

Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with increased neonatal morbidity and mortality as well as short stature, cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia and end-stage renal disease in adulthood. In addition, SGA children have decreased levels of intelligence and cognition, although the effects are mostly

H. M. A. de Bie; K. J. Oostrom; H. A. Delemarre-van de Waal

2010-01-01

375

Uncontrollable Rotational Motion of the Mir Orbital Station  

NASA Astrophysics Data System (ADS)

The results of determining the rotational motion of the Mir orbital station are presented for four long segments of its unmanned uncontrolled flight in 1999-2000. The determination was carried out using the data of onboard measurements of the Earth's magnetic field intensity. These data, taken for a time interval of several hours, were jointly processed by the least squares method with the help of integration of the equations of station motion relative to its center of mass. As a result of this processing, the initial conditions of motion and the parameters of the mathematical model used were evaluated. The technique of processing is verified using the telemetry data on angular velocity of the station and its attitude parameters. Two types of motion were applied on the investigated segments. One of them (three segments) presents a rotation around the axis of the minimum moment of inertia. This axis executes small oscillations with respect to a normal to the orbit plane. Such a motion was used for the first time on domestic manned orbital complexes. The second type of motion begins with a biaxial rotation which, in a few weeks, goes over into a motion very similar to the rotation around the normal to the orbit plane, but around the axis of the maximum moment of inertia.

Babkin, E. V.; Belyaev, M. Yu.; Efimov, N. I.; Sazonov, V. V.; Stazhkov, V. M.

2001-01-01

376

Uncontrollable frenzy and a unique temporary insanity plea.  

PubMed

On a bright, sunny April 1859 afternoon in Washington, D.C., a brutal murder occurred in Lafayette Park, directly across from the White House. Ironically, a close friend of President James Buchanan shot and killed his wife's lover. Daniel E. Sickles, a cuckolded U.S. Congressman, attacked and killed Philip Barton Key, the U.S. Attorney for the District of Columbia. Key was one of the eleven children of Francis Scott Key, the author of the poem that became The Star Spangled Banner. At the trial, Sickles' seven lawyers presented an insanity plea claiming that an "uncontrollable frenzy" created a 'brainstorm" resulting in temporary insanity. In addition, the defense argued that the "unwritten law" provided immunity to a husband who avenged his honor. Only lay witnesses testified as to Sickles' intense emotional outrage. There was no expert medical witness to support the insanity plea. Prosecutors maintained that the killing was a premeditated murder, or at the very least manslaughter. PMID:10794208

Spiegel, A D; Suskind, P B

2000-04-01

377

Gestational weight gain, prepregnancy body mass index related to pregnancy outcomes in KAZERUN, FARS, IRAN  

PubMed Central

Objective: The aim of this study was to evaluate associations between pregnancy outcomes and prepregnancy body mass index and gestational weight gain among pregnant women who regularly attended health centers of Kazerun, Fars, Iran. Methods: In this descriptive study records from 5172 pregnant women were considered in this study, based on the methodology criteria. Women were distributed across 4 prepregnancy categories according to the Institute of Medicine (IOM) (1990) classification of body mass index, and to 4 end-of-pregnancy categories according to median weekly gestational weight gain. Results: The risks for gestational diabetes, gestational hypertension, pre-eclampsia, and preterm premature rupture of membranes were higher for those who were overweight or obese before becoming pregnant (P < 0.05). Moreover, a gestational weight gain of 0.50 kg per week or greater was associated with a higher risk for gestational hypertension, preterm premature rupture of membranes, and fetal macrosomia (P < 0.05). Women in the highest quartile for weight gain (? 0.59 kg per week) were at higher risk for pre-eclampsia (P < 0.05). Discussion: The results seems to indicate that excessive gestational weight gain and high prepregnancy body mass index were associated with increased risks for adverse pregnancy outcomes.

Tabatabaei, Mozhgan

2011-01-01

378

The Effects of Uncontrollable Stress on Subjective Well-Being and Coping Behavior in Urban Adolescents  

Microsoft Academic Search

The purpose of this dissertation was to determine whether uncontrollable and controllable stressors differentially affected levels of subjective well-being in a group of ethnically diverse urban adolescents. Additionally, the researcher examined what types of coping skills were utilized in the face of high levels of uncontrollable stress. Lastly, a moderational model was proposed, wherein active coping was hypothesized to strengthen

Laura Darr Coyle

2010-01-01

379

Diabetic Mastopathy: An Uncommon Complication of Diabetes Mellitus  

PubMed Central

Introduction. Whilst most consequences of diabetes mellitus are well recognized, breast-related complications remain obscure. The term diabetic mastopathy (DMP) attempts to describe the breast-related consequences of diabetes. Methods. We report the clinicopathologic findings in a patient with DMP and review the literature on this uncommon entity. Results. A 33-year-old woman with type 1 diabetes had excision biopsy of a 2?cm breast lump. Histopathologic evaluation revealed classic features of DMP: parenchymal fibrosis; keloid-like hyalinization of interlobular stroma; adipose tissue entrapment; lobular compression; dense chronic inflammatory cell infiltration; and lymphoid follicle formation. Conclusion. Clinicians should be aware of DMP as a differential for breast disease in women with uncontrolled diabetes.

Kirby, R. X.; Mitchell, D. I.; Williams, N. P.; Cornwall, D. A.; Cawich, S. O.

2013-01-01

380

Mucormycosis in a diabetic ketoacidosis patient.  

PubMed

Oral cavity is considered to be a kaleidoscope for body's general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis. PMID:24075351

Vijayabala, G Sree; Annigeri, Rajeshwari G; Sudarshan, Ramachandran

2013-09-04

381

Mucormycosis in a diabetic ketoacidosis patient  

PubMed Central

Oral cavity is considered to be a kaleidoscope for body's general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.

Vijayabala, G. Sree; Annigeri, Rajeshwari G; Sudarshan, Ramachandran

2013-01-01

382

Utilizing a diabetic registry to manage diabetes in a low-income Asian American population.  

PubMed

Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management. PMID:22192058

Seto, Winnie; Turner, Barbara S; Champagne, Mary T; Liu, Lynn

2011-12-22

383

42 CFR 410.130 - Definitions.  

Code of Federal Regulations, 2010 CFR

...with symptoms of uncontrolled diabetes. Episode of care means...when coordinated with initial diabetes self-management training...The time period covered for gestational diabetes extends only until the...

2009-10-01

384

42 CFR 410.130 - Definitions.  

Code of Federal Regulations, 2010 CFR

...with symptoms of uncontrolled diabetes. Episode of care means...when coordinated with initial diabetes self-management training...The time period covered for gestational diabetes extends only until the...

2010-10-01

385

Lactation, diabetes, and nutrition recommendations  

Microsoft Academic Search

Human milk is recommended for infants throughout at least the first year of life. Breastfeeding is also recommended for infants\\u000a of women with preexisting diabetes or gestational diabetes. Dietary Reference Intakes (DRIs) 2002 provides recommendations for energy and macronutrients for all ages and for pregnancy and lactation. During the\\u000a first 6 months, infants receive an average of 500 kcal\\/d from

Diane Reader; Marion J. Franz

2004-01-01

386

Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-Income Latinos: Latinos en Control  

Microsoft Academic Search

BACKGROUND: US Latinos have greater prevalence of type 2 diabetes (diabetes), uncontrolled diabetes and diabetes co-morbidities compared to non-Latino Whites. They also have lower literacy levels and are more likely to live in poverty. Interventions are needed to improve diabetes control among low-income Latinos. METHODS AND DESIGN: This randomized clinical trial tested the efficacy of a culturally- and literacy-tailored diabetes

Milagros C. Rosal; Mary Jo White; Angela Restrepo; Barbara C. Olendzki; Jeffrey Scavron; Elise Sinagra; Ira S. Ockene; Michael Thompson; Stephenie C. Lemon; Lucy M. Candib; George W. Reed

2009-01-01

387

Diabetic nephropathy: causes and managements.  

PubMed

Uncontrolled diabetic patients often develop diabetic nephropathy (DN). Since, it involves different molecular pathways, such as polyol pathway, protein kinase-C (PKC) activation, inflammatory and oxidative stress etc., and so multi-targeted drugs would be required for its management. Although, combination therapies with various conventional medicines are already in use, but herbal preparations are being preferred as adjuvant therapy, because of their multi targeted drug action due to the presence of natural cocktail of various secondary metabolites. This review describes pathogenesis of DN, possible approaches for its management and information about recent patents and bio-products, which are in pipe line of drug development. PMID:23227864

Tripathi, Yamini B; Yadav, Durgavati

2013-01-01

388

Women and Diabetes -- Diabetes Medicines  

MedlinePLUS

Women and Diabetes - Diabetes Medicines Click here for the Color Version (PDF 518 KB) Diabetes can make it hard to control how much ... Warning Signs Diabetes Medicines Learn More about Diabetes Diabetes Tips Talk to your doctor before you change ...

389

Quasistatic Treatment of the Influence of Bandlimited White Reactivity Noise on an Uncontrolled Critical Point Reactor.  

National Technical Information Service (NTIS)

The quasistatic (or prompt jump) treatment has been used to investigate the effect of bandlimited white reactivity noise on the kinetic behaviour of an uncontrolled critical point reactor. This treatment is valid for noise with a corner frequency << beta ...

N. K. Bansal H. Borgwaldt

1977-01-01

390

Exposure to uncontrollable stress and the postimperative negative variation (PINV): prior control matters.  

PubMed

The main goal of this study was to assess cortical functioning as indexed by the postimperative negative variation (PINV) induced by uncontrollable stress. Sixty-six persons were randomly assigned to three groups who underwent different sequences of stressor controllability. Within an S1-S2 paradigm, one group had initial control over aversive stimulation followed by loss of control and restitution of control. The other groups initially experienced either uncontrollability or controllability followed by a condition of control. Uncontrollable stress significantly enhanced PINV magnitudes independent of preceding control. However, control over aversive stimulation prior to loss of control normalized PINVs during restitution of control. Persons not experiencing prior control showed enhanced PINVs, longer reaction times, and more errors during restitution of control. We conclude that cortical activation changes are linked to the evaluation of instrumental contingencies. However, the exact determination of brain regions involved in the processing of uncontrollable stress needs further investigation. PMID:18838101

Diener, Carsten; Struve, Maren; Balz, Nicole; Kuehner, Christine; Flor, Herta

2008-09-16

391

Statistical evaluation of groundwater quality around an uncontrolled landfill: implication for plume migration pathways  

Microsoft Academic Search

When leachate emanates from an uncontrolled landfill, it poses a threat to the groundwater resources of the surrounding areas.\\u000a Thus, regular monitoring is essential to protect the groundwater from contamination. In this study, an evaluation is carried\\u000a out on the quality of groundwater affected by the leachate deriving from an uncontrolled landfill situated in a valley. A\\u000a nonparametric trend analysis

Joung-Ku Park; Jin-Yong Lee; Tae-Dong Kim

2008-01-01

392

Developing Criteria for Defining Type 2 Diabetes in Pregnancy  

Microsoft Academic Search

In 1997, the American Diabetes Association (ADA) announced new diagnostic criteria (1) for diabetes and set the definition of gestational diabetes (GDM). Before 1991, GDM was defined as “a transient abnormality\\u000a of glucose tolerance during pregnancy”(2,3). However, the 1997 definition of GDM by the ADA includes diabetes mellitus diagnosed during pregnancy. This definition ignores\\u000a the added risks to the mother

Lois Jovanovic; Seanna Martin

393

Detection of Mogibacterium timidum in subgingival biofilm of aggressive and non-diabetic and diabetic chronic periodontitis patients  

PubMed Central

The aim of the present study was to evaluate the frequency of detection of Mogibacterium timidum in subgingival samples of subjects with generalized aggressive periodontitis (GAgP) and uncontrolled diabetic and non-diabetic subjects with generalized chronic periodontitis (GChP). 48 patients with GAgP, 50 non-diabetic and 39 uncontrolled (glycated hemoglobin >7%) type 2 diabetic subjects with GChP were enrolled in this study. Subgingival biofilm were collected from deep pockets (probing depth > 7 mm). After DNA extraction, M. timidum was detected by Nested Polymerase Chain Reaction and chi-square test was used to data analysis (p>0.05). There were no differences in the frequency of detection of M. timidum between subjects with GAgP (35%) and non-diabetic subjects with GChP (40%) (p>0.05). The frequency of detection of M. timidum was significantly higher in deep pockets of diabetic subjects with GChP (56%) when compared to GAgP (p<0.05), but similar to non-diabetic subjects with GChP (p>0.05). The frequency of detection of M. timidum was higher in subjects GChP presenting uncontrolled type 2 diabetes mellitus, when compared to GAgP subjects.

Casarin, Renato Correa Viana; Saito, Daniel; Santos, Vanessa Renata; Pimentel, Suzana Peres; Duarte, Poliana Mendes; Casati, Marcio Zaffalon; Goncalves, Reginaldo Bruno

2012-01-01

394

Pregnancy outcome following gestational exposure to azithromycin  

Microsoft Academic Search

BACKGROUND: Azithromycin is an azalide antibiotic with an extensive range of indications and has become a common treatment option due to its convenient dosing regimen and therapeutic advantages. Human studies addressing gestational use of azithromycin have primarily focused on antibiotic efficacy rather than fetal safety. Our primary objective was to evaluate the possibility of teratogenic risk following gestational exposure to

Moumita Sarkar; Cindy Woodland C; Gideon Koren; Adrienne RN Einarson

2006-01-01

395

Diabetic parturient - Anaesthetic implications  

PubMed Central

Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate gestational diabetes develops. ‘Gestational diabetes mellitus’ (GDM) is defined as carbohydrate intolerance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 DM as are their children. Thus GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention. Timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycaemia in them and ensuring adequate nutrition may prevent in all probability, the vicious cycle of transmitting glucose intolerance from one generation to another. Given that diabetic mothers have proportionately larger babies it is likely that vaginal delivery will be more difficult than in the normal population, with a higher rate of instrumentally assisted delivery, episiotomy and conversion to urgent caesarean section. So an indwelling epidural catheter is a better choice for labour analgesia as well to use, should a caesarean delivery become necessary. Diabetes in pregnancy has potential serious adverse effects for both the mother and the neonate. Standardized multidisciplinary care including anaesthetists should be carried out obsessively throughout pregnancy. Diabetes is the most common endocrine disorder of pregnancy. In pregnancy, it has considerable cost and care demands and is associated with increased risks to the health of the mother and the outcome of the pregnancy. However, with careful and appropriate screening, multidisciplinary management and a motivated patient these risks can be minimized.

Pani, Nibedita; Mishra, Shakti Bedanta; Rath, Shovan Kumar

2010-01-01

396

Breastfeeding and diabetes.  

PubMed

The present review outlines the role of breastfeeding in diabetes. In the mother, breastfeeding has been suggested to reduce the incidence of type 2 diabetes mellitus, the metabolic syndrome and cardiovascular disease. Moreover, it appears to reduce the risk of premenopausal breast cancer and ovarian cancer. In the neonate and infant, among other benefits, lactation confers protection from future both type 1 and type 2 diabetes. Whether lactation protects women with gestational diabetes mellitus and their offspring from future T2DM remains to be answered. Importantly, for diabetic mothers, antidiabetic treatment itself may affect breastfeeding. There is not enough data to allow the use of oral hypoglycaemic agents. Therefore, insulin currently remains the optimal antidiabetic treatment during lactation. In conclusion, breastfeeding could be considered a modifiable risk factor for the development of diabetes and even a potential protective lifestyle measure from future cardio-metabolic and malignant diseases. Therefore, health care professionals should encourage both women with and without diabetes to breastfeed their children. PMID:21348815

Gouveri, E; Papanas, N; Hatzitolios, A I; Maltezos, E

2011-03-01

397

Diabetes Insipidus  

MedlinePLUS

... Z List of Topics and Titles : Diabetes Insipidus Diabetes Insipidus On this page: What is diabetes insipidus? ... Hope through Research For More Information What is diabetes insipidus? Diabetes insipidus (DI) is a rare disease ...

398

Diabetes - resources  

MedlinePLUS

Resources - diabetes ... The following sites provide further information on diabetes : American Diabetes Association - www.diabetes.org Juvenile Diabetes Research Foundation International - www.jdrf.org National Center for Chronic Disease Prevention and Health Promotion - ...

399

Did You Have Gestational Diabetes When You Were Pregnant?  

MedlinePLUS

... that are fresh, frozen, or canned in water • lean meats, chicken and turkey with the skin removed, ... of Southern California and attending physician at Children’s Hospital Los Angeles reviewed this material for accuracy. HHS’ ...

400

Exercise Recommendations in Women with Gestational Diabetes Mellitus  

Microsoft Academic Search

\\u000a Experts agree that pregnancy and postpartum are valuable periods during which to undertake proactive and preventative health\\u000a care of modifiable risk factors through physical activity. In this chapter, we review the physiologic rationale for exercise\\u000a during GDM and for GDM prevention, studies addressing these topics, and current recommendations for physical activity regarding\\u000a GDM. We also suggest modifications to the current

Raul Artal; Gerald S. Zavorsky; Rosemary B. Catanzaro

401

Pharmacotherapy of gestational trophoblastic disease.  

PubMed

Gestational trophoblastic neoplasms are the most responsive of all solid tumours to chemotherapy leading to an overall cure rate of > 90%. Non-metastatic disease (FIGO Stage I) and low-risk metastatic disease (FIGO Stages II and III; WHO score < 7) can be treated with single-agent methotrexate or actinomycin D protocols resulting in a survival rate approaching 100%. Metastatic high-risk disease (FIGO Stage IV or WHO score > 7) should be treated with initial intensive multimodality therapy with combination chemotherapy, consisting of etoposide, high-dose methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) and adjuvant radiotherapy and surgery when indicated. Despite this aggressive approach, approximately 30% of patients with high-risk disease will fail initial therapy or relapse from remission. Salvage chemotherapy with drug regimens containing platinum agents and etoposide, usually in conjunction with bleomycin or ifosfamide, as well as surgical resection of sites of resistant disease, will ultimately result in a survival rate of 80 - 90% for metastatic high-risk disease. PMID:14596654

Lurain, John R

2003-11-01

402

Molecular mechanisms in the pathogenesis of diabetic nephropathy: an update.  

PubMed

Diabetes mellitus is known to trigger retinopathy, neuropathy and nephropathy. Diabetic nephropathy, a long-term major microvascular complication of uncontrolled hyperglycemia, affects a large population worldwide. Recent findings suggest that numerous pathways are activated during the course of diabetes mellitus and that these pathways individually or collectively play a role in the induction and progression of diabetic nephropathy. However, clinical strategies targeting these pathways to manage diabetic nephropathy remain unsatisfactory, as the number of diabetic patients with nephropathy is increasing yearly. To develop ground-breaking therapeutic options to prevent the development and progression of diabetic nephropathy, a comprehensive understanding of the molecular mechanisms involved in the pathogenesis of the disease is mandatory. Therefore, the purpose of this paper is to discuss the underlying mechanisms and downstream pathways involved in the pathogenesis of diabetic nephropathy. PMID:23313806

Arora, Mandeep Kumar; Singh, Umesh Kumar

2013-01-11

403

Mode of Delivery and Neonatal Outcomes in Preterm, Small-for-Gestational-Age Newborns  

PubMed Central

Objective To compare neonatal outcomes by method of delivery in preterm (34 weeks of gestation or prior), small-for-gestational-age (SGA) newborns in a large diverse cohort. Methods Birth data for 1995–2003 from New York City were linked to hospital discharge data. Data were limited to singleton, liveborn, vertex neonates delivered between 25 and 34 weeks of gestation. Births complicated by known congenital anomalies and birth weight less than 500 g were excluded. Small for gestational age was used as a surrogate for intrauterine growth restriction. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. Results Two thousand eight hundred eighty-five SGA neonates meeting study criteria were identified; 42.1% were delivered vaginally, and 57.9% were delivered by cesarean. There was no significant difference in intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis between the cesarean delivery and vaginal delivery groups. Cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress syndrome. The increased odds persisted after controlling for maternal age, parity, ethnicity, education, primary payer, prepregnancy weight, gestational age at delivery, diabetes, and hypertension. Conclusion Cesarean delivery was not associated with improved neonatal outcomes in preterm SGA newborns and was associated with an increased risk of respiratory distress syndrome.

Werner, Erika F.; Savitz, David A.; Janevic, Teresa M.; Ehsanipoor, Robert M.; Thung, Stephen F.; Funai, Edmund F.; Lipkind, Heather S.

2013-01-01

404

Metabolic syndrome in children born small-for-gestational age.  

PubMed

Being born small-for-gestational age and a rapid increase in weight during early childhood and infancy has been strongly linked with chronic diseases, including metabolic syndrome, which has been related to intrauterine life environment and linked to epigenetic fetal programming. Metabolic syndrome includes waist circumference ? 90(th) percentile for age, sex and race, higher levels of blood pressure, triglycerides and fasting glucose, and low levels of HDL-cholesterol. Insulin resistance may be present as early as 1 year of age, and obesity and/or type 2 diabetes are more prevalent in those born SGA than those born AGA. The programming of adaptive responses in children born SGA includes an association with increased blood pressure, changes in endothelial function, arterial properties and coronary disease. Early interventions should be directed to appropriate maternal nutrition, before and during pregnancy, promotion of breast feeding, and prevention of rapid weight gain during infancy, and to promote a healthy lifestyle. PMID:22218440

Hernández, María Isabel; Mericq, Verónica

2011-11-01

405

Diabetes in Canadian Women  

PubMed Central

Health Issue Diabetes mellitus (DM) is a chronic health condition affecting 4.8% of Canadian adults ? 20 years of age. The prevalence increases with age. According to the National Diabetes Surveillance System (NDSS) (1998–1999), approximately 12% of Canadians aged 60–74 years are affected. One-third of cases may remain undiagnosed. The projected increase in DM prevalence largely results from rising rates of obesity and inactivity. Key Findings DM in Canada appears to be more common among men than women. However, among Aboriginal Canadians, two-thirds of affected individuals are women. Although obesity is more prevalent among men than women (35% vs. 27%), the DM risk associated with obesity is greater for women. Socio-economic status is inversely related to DM prevalence but the income-related disparities are greater among women. Polycystic ovarian syndrome affects 5–7% of reproductive-aged women and doubles their risk for DM. Women with gestational diabetes frequently develop DM over the next 10 years. Data Gaps and Recommendations Studies of at risk ethnic/racial groups and women with gestational diabetes are needed. Age and culturally sensitive programs need to be developed and evaluated. Studies of low-income diabetic women are required before determining potential interventions. Lifestyle programs in schools and workplaces are needed to promote well-being and combat obesity/inactivity, together with lobbying of the food industry for needed changes. High depression rates among diabetic women influence self-care ability and health care expenditures. Health professionals need further training in the use of effective counseling skills that will assist people with DM to make and maintain difficult behavioural changes.

Kelly, Catherine; Booth, Gillian L

2004-01-01

406

Involvement of the skeletal GH-IGF system in an experimental model of diabetes-induced growth retardation  

Microsoft Academic Search

Uncontrolled diabetes is associated with growth retardation. We investigated the effect of insulin-dependent diabetes on\\u000a animal growth and IGF-I gene expression in the epiphyseal growth plate region of the long bones. We also studied the effect\\u000a of GH administration on somatic growth in the diabetic state. Streptozotocin (STZ)-injected diabetic rats had a decreased\\u000a somatic growth rate in comparison to controls.

Y. Segev; D. Landau; S. Davidoff-Friedman; M. Weinreb; M. Phillip

2002-01-01

407

Arginine vasopressin: a promising rescue drug in the treatment of uncontrolled haemorrhagic shock.  

PubMed

Haemorrhagic shock is one of the most frequent types of shock. If haemorrhage cannot be controlled and fluid resuscitation as well as catecholamines are insufficient to stabilize cardiovascular function, uncontrolled haemorrhagic shock occurs. Several approaches have been suggested as promising alternatives to volume resuscitation. The rationale for the use of arginine vasopressin (AVP) is the pharmacologic amplification of the neuroendocrine stress response. AVP-mediated vasoconstriction is the first physiologic step to haemostasis and shifts blood away from the bleeding site towards the heart, lungs and brain. Particularly, when uncontrolled haemorrhage is accompanied by traumatic brain injury this may help to reduce secondary neurological damage. Since AVP can prevent acute death only transiently, it must comprehensively be combined with rapid hospital admission, immediate control of haemorrhage followed by aggressive fluid resuscitation and blood transfusion. This review article summarizes current experimental and clinical evidence on the use of AVP in uncontrolled haemorrhagic shock. PMID:18683476

Wenzel, Volker; Raab, Helmut; Dünser, Martin W

2008-06-01

408

Symptoms, Feelings, Activities and Medication Use in Adolescents With Uncontrolled Asthma: Lessons Learned From Asthma Diaries.  

PubMed

This study was to describe symptoms, feelings, activities and medication use reported by adolescents with uncontrolled asthma on their 24-hour asthma diaries. Adolescents with uncontrolled asthma (13-17years, N=29) completed asthma diaries and audio-recorded symptom sounds for 24hours. A variety of symptoms were reported, and the most frequently reported symptoms were coughing followed by wheezing. Most self-reported coughing and wheezing were verified by audio-recordings. Participants reported predominantly negative feelings and low levels of activities. High discordance between self-reports and medical records in medications was noted, raising a concern of poor treatment adherence in this vulnerable group. PMID:23685266

Rhee, Hyekyun; Fairbanks, Eileen; Butz, Arlene

2013-05-15

409

Embryonic Pig Pancreatic Tissue Transplantation for the Treatment of Diabetes  

Microsoft Academic Search

BackgroundTransplantation of embryonic pig pancreatic tissue as a source of insulin has been suggested for the cure of diabetes. However, previous limited clinical trials failed in their attempts to treat diabetic patients by transplantation of advanced gestational age porcine embryonic pancreas. In the present study we examined growth potential, functionality, and immunogenicity of pig embryonic pancreatic tissue harvested at different

Smadar Eventov-Friedman; Dalit Tchorsh; Helena Katchman; Elias Shezen; Anna Aronovich; Gil Hecht; Benjamin Dekel; Gideon Rechavi; Bruce R. Blazar; Ilan Feine; Orna Tal; Enrique Freud; Yair Reisner

2006-01-01

410

Maternal diabetes: The risk for specific birth defects  

Microsoft Academic Search

We studied the risk for specific birth defects among infants of mothers with gestational and chronic diabetes using data collected by the Spanish Collaborative Study of Congenital Malformations (ECEMC). For the years 1976 to 1985, we identified 10,087 infants with malformations and 9,994 control infants; 155 of the case infants and 89 of the controls were born to diabetic mothers.

M. A. Ramos-Arroyo; E. Rodriguez-Pinilla; J. F. Cordero

1992-01-01

411

Oxytocin and Psychological Factors Affecting Type 2 Diabetes Mellitus  

PubMed Central

Background. The aim of this study was to investigate the association of oxytocin with trait and state psychological factors in type 2 diabetic patients. Methods. OXT and psychological variables were analyzed from 86 controlled diabetic patients (glycosylated haemoglobin A1c (HbA1c) < 7%) from 45 uncontrolled diabetic patients (HbA1c ? 7). Psychological characteristics were assessed with the Eysenck Personality Questionnaire (EPQ), while state psychological characteristics were measured with the Symptom Checklist 90-R (SCL 90-R). Blood samples were taken for measuring oxytocin in both subgroups during the initial phase of the study. One year later, the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments. Results. During the first evaluation of the uncontrolled diabetic patients, a statistically significant positive relationship between the levels of OXT and psychoticism in EPQ rating scale (P < 0.013) was observed. For controlled diabetic patients, a statistically significant negative relationship between oxytocin and somatization (P < 0.030), as well as obsessive-compulsive scores (P < 0.047) in SCL-90 rating scale, was observed. During the second assessment, the values of OXT decreased when the patients managed to control their metabolic profile. Conclusions. The OXT is in association with psychoticism, somatization, and obsessionality may be implicated in T2DM.

Kontoangelos, K.; Raptis, A. E.; Papageorgiou, C. C.; Tsiotra, P. C.; Papadimitriou, G. N.; Rabavilas, A. D.; Dimitriadis, G.; Raptis, S. A.

2012-01-01

412

Modeling and Decoupling Control of ICE APU with Uncontrolled Rectifier in Series Hybrid Vehicle  

Microsoft Academic Search

In series hybrid vehicle ICE (internal combustion engine), generator with rectifier and exciter are connected together as APU (Auxiliary Power Unit) to provide electricity for vehicle power system. The use of uncontrolled diode rectifier after AC synchronous generator can reduce system cost, but also makes the system difficult to control due to lacking of control variables. In order to achieve

Shuo Tian; Guijun Cao; Qiang Han; Jianqiu Li; Minggao Yang

2006-01-01

413

Uncontrolled hazardous waste site cleanup programs in the US: An overview  

Microsoft Academic Search

Problems concerning environmental contamination resulting from releases of hazardous substances at uncontrolled hazardous waste sites have received widespread attention in the US since the early 1980s. Today, the Superfund program established under CERCLA and SARA is one of the most ambitious and expensive environmental efforts ever attempted in this nation. The US Environmental Protection Agency (US EPA) has already spent

Shen-yann Chiu; S. Y. Tsai

1989-01-01

414

Transvenous Embolization to Treat Uncontrolled Hemobilia and Peritoneal Bleeding After Transjugular Liver Biopsy  

SciTech Connect

Hemobilia is one of the complications that can occur after a transjugular liver biopsy. Various treatment options have been described for the management of this condition, including transarterial embolization and open surgery. We describe a patient who developed uncontrolled hemobilia after a transjugular liver biopsy that required a transvenous approach for embolization and treatment purposes.

Koshy, Chiramel George, E-mail: gkchiramel@gmail.co [Christian Medical College, Department of Radiology (India); Eapen, C. E. [Christian Medical College, Department of Clinical Gastroenterology and Hepatology (India); Lakshminarayan, Raghuram [Christian Medical College, Department of Radiology (India)

2010-06-15

415

A method for the remote sensing identification of uncontrolled landfills: formulation and validation  

Microsoft Academic Search

The identification of uncontrolled landfills is a central environmental problem in all developed and developing countries, where several illegal waste deposits exist as a result of rapid industrial growth over the past century. Remote sensing can potentially provide crucial information for the identification of contaminated sites, but surprisingly there is a marked lack of rigorously validated approaches. In this paper

S. Silvestri; M. Omri

2008-01-01

416

Uncontrolled generator operation of interior PM synchronous machines following high-speed inverter shutdown  

Microsoft Academic Search

Interior permanent magnet (IPM) synchronous machine drives are vulnerable to a special fault mode when gating is suddenly removed from the inverter switches during high-speed operation. The resulting IPM machine operation as a generator in combination with an uncontrolled rectifier must be properly understood and accounted for in the machine design to avoid damage to either the machine or inverter.

Thomas M. Jahns

1998-01-01

417

Uncontrolled generator operation of interior PM synchronous machines following high-speed inverter shutdown  

Microsoft Academic Search

Interior permanent magnet (IPM) synchronous machine drives are vulnerable to a special fault mode when gating is suddenly removed from the inverter switches during high-speed operation. The resulting IPM machine operation as a generator in combination with an uncontrolled rectifier must be properly understood and accounted for in the machine design to avoid damage to either the machine or inverter.

Thomas M. Jahns; Vahe Caliskan

1999-01-01

418

Computing the Distance to Uncontrollability via LMIs: Lower and Upper Bounds Computation and Exactness Verification  

Microsoft Academic Search

In this paper, we consider the problem to compute the distance to uncontrollability of a given controllable pair A isin C n times n and B isin Cn times m. It is known that this problem is equivalent to computing the minimum of the smallest singular value of [ A - zI B ] over z isin C. With this

Yoshio Ebihara; Tomomichi Hagiwara

2006-01-01

419

Uncontrollability and Unpredictability in Post-Traumatic Stress Disorder: An Animal Model  

Microsoft Academic Search

The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of

Edna B. Foa; Richard Zinbarg; Barbara Olasov Rothbaum

1992-01-01

420

Uncontrolled Attitude Motion of the Orbital Station MIR in the Last Year of its Flight  

Microsoft Academic Search

We analyze the real attitude motion of the orbital station Mir during long periods of its uncontrolled flight without a crew in 1999 - 2001. The motion was reconstructed by processing on board measurements of the Earth magnetic field strength. Every day, there was a run of measurements. The run duration was about an orbital revolution. The measurement data, obtained

M. Yu. Beliaev; V. M. Stazhkov; E. V. Babkin; V. V. Sazonov

2004-01-01