The National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network randomized clinical trial in progress: standard therapy versus no therapy for mild gestational diabetes.

Department of Obstetrics, Ohio State University, Columbus, Ohio 43210-1228, USA.
Diabetes care (Impact Factor: 8.57). 08/2007; 30 Suppl 2:S194-9. DOI: 10.2337/dc07-s215
Source: PubMed
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    ABSTRACT: Abstract Objective: To identify the accuracy of diagnosing postpartum diabetes and glucose intolerance using antepartum glycosylated hemoglobin (HbA1c) and fasting glucose values. Study Design: A retrospective Hawaiian cohort of women with gestational diabetes during 2004-2011 were evaluated. Antepartum HbA1c and postpartum 75-g glucose tolerance tests were obtained. Results: An antepartum HbA1c value of ≥6.5% had a 45.7% sensitivity, a 96% specificity and a 40% positive predictive value (PPV) for predicting postpartum diabetes. An antepartum HbA1c value of ≥6.5% had a 6.6% sensitivity, a 94.2% specificity and a 27% PPV for predicting postpartum impaired glucose tolerance. An antepartum HbA1c value of ≥6.5% had a 10.3% sensitivity, a 95.7% specificity and a 33.3% PPV for predicting postpartum impaired fasting glucoses. Conclusion: We could not demonstrate a clinically useful PPV for diagnosing postpartum diabetes or glucose intolerance using an antepartum elevated HbA1c value of ≥6.5% or a fasting glucose level of ≥90 mg/dL.
    American Journal of Obstetrics and Gynecology 10/2014; DOI:10.1515/jpm-2014-0162 · 3.97 Impact Factor
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    ABSTRACT: As the prevalence of diabetes continues to rise worldwide, it is increasingly important to identify high-risk populations and to implement strategies to delay or prevent diabetes onset. Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, both currently epidemic in the United States. Diagnosis of GDM, therefore, provides an excellent opportunity to intervene years before the development of this disorder. Indeed, women may be more likely to adopt healthy lifestyle habits during pregnancy and maintain these habits into the postpartum period. This chapter will summarize interventions which rely on lifestyle modifications to prevent GDM or mitigate the effects of GDM during pregnancy. These include changes in diet, as well as physical activity, both of which are established risk factors in the prevention and treatment of type 2 diabetes. The chapter concludes with recommendations for future intervention studies.
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    ABSTRACT: To evaluate the effect of maternal body mass index (BMI) on gestational diabetes (GDM) and the risk of adverse pregnancy outcomes in women who are overweight or obese. A prospective cohort study nested within the LIMIT randomised controlled trial. A total of 1030 women were recruited between 10 and 20 weeks' gestation, with a BMI≥25kg/m(2), and were grouped into BMI subclasses utilising World Health Organisation criteria. Women underwent a fasting oral glucose tolerance test at 26-28 weeks' gestation, and a diagnosis of GDM was made if fasting blood glucose was ≥5.5mmol/L or ≥7.8mmol/L after 2h. Maternal and neonatal health outcomes were evaluated. The prevalence of GDM increased with increasing maternal BMI (6.74% overweight vs 13.42% obese subclass 1 vs 12.79% obese subclass 2 vs 20.00% obese subclass 3). Women who were diagnosed with GDM were significantly less likely to give birth to an infant with birth weight above 4kg (RR 0.60; 95% CI 0.36 to 1.00; p=0.05). The need for caesarean delivery (RR 1.27; 95% CI 1.07 to 1.50; p=0.006) and incidence of birth weight >90% (RR 1.38; 95% CI 1.07 to 1.77; p=0.01) was significantly increased in women who were obese, independent of GDM. Increasing maternal BMI is a significant risk factor for the development of GDM, and our findings demonstrate a considerably higher prevalence than has been previously described. Raised maternal BMI is a risk factor for high infant birth weight, which may be modified by lifestyle intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Diabetes research and clinical practice 02/2015; DOI:10.1016/j.diabres.2014.12.015 · 2.54 Impact Factor