M Bonomo

Azienda Ospedaliera Niguarda Ca' Granda, Milano, Lombardy, Italy

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Publications (20)52.84 Total impact

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    ABSTRACT: The best way to treat pregnant patients who have type 1 diabetes is still unclear. For this reason, the present study compared metabolic control and maternal-fetal outcomes in patients treated with continuous subcutaneous infusions of rapid-acting insulin analogues (CSII) or with insulin glargine and multiple daily injections of rapid-acting insulin analogues (glargine-MDI). This retrospective multicentre study involved 144 women with type 1 diabetes, 100 of whom were using CSII and 44 glargine-MDI. Outcomes analyzed were metabolic control, diabetes complications, pregnancy outcome, perinatal morbidity and mortality, and fetal malformations. The two groups were comparable for age, prepregnancy BMI, primiparous rate and diabetes complications, although patients using CSII had longer duration of diabetes (P=0.03) and higher White classifications (P=0.04). In both groups, metabolic control improved during pregnancy, but good control was reached earlier among patients using CSII. At parturition, patients using CSII had lower HbA(1c) (6.2±0.7% vs 6.5±0.8%; P=0.02) and required less insulin (P<0.01). Weight gain was similar in both groups, and maternal-fetal outcomes did not differ. In pregnant patients with type 1 diabetes, MDI and CSII are equivalent in terms of metabolic control and fetal-maternal outcomes, although patients using CSII achieved good control earlier and with less insulin.
    Diabetes & Metabolism 04/2011; 37(5):426-31. · 2.39 Impact Factor
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    ABSTRACT: This multicentre study analyzed the maternal and fetal outcomes of women who had one elevated 3-h oral glucose tolerance test (isolated gestational hyperglycaemia [IGH]). From 1999 to 2003, data were collected for 606 IGH women from 31 Italian obstetric or diabetic centres, including time and mode of delivery, gestational hypertension, preeclampsia, eclampsia, congenital malformations, and neonatal mortality and morbidity, to compare them with the general pregnant Italian population. A prognostic model for the outcome of pregnancy was constructed, and the concurrence of certain specified conditions was considered a positive outcome, whereas pregnancies that failed to meet one or more of the stated conditions were classified as "complicated". Macrosomia was significantly more frequent in women with IGH than in the normal pregnant population (10.7 vs 7.4%, respectively; P=0.003). Stillbirth and neonatal mortality rates did not differ from those in normal pregnancies, while a slight rise in the frequency of major malformations was not statistically significant (1.48 vs 0.89%, respectively; P<0.11). Multivariate logistic analyses confirmed that the prepregnancy body mass index (BMI) was an independent predictor of a complicated pregnancy. As for fetal growth, multivariate logistic analyses according to BMI showed that being overweight or obese were strong predictors of macrosomia. These findings in a large cohort of Italian women with IGH confirm the detrimental effect of even minimally altered glucose tolerance on fetal outcome. Also, prepregnancy obesity plays an important role in raising the risk of adverse perinatal outcomes in such patients.
    Diabetes & Metabolism 09/2010; 36(4):265-70. · 2.39 Impact Factor
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    ABSTRACT: AimTo verify whether, with thorough practical and theoretical training, well-controlled, non-complicated diabetic patients can safely go diving underwater with no additional medical or metabolic risks.
    Diabetes & Metabolism 07/2009; · 2.39 Impact Factor
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    ABSTRACT: To compare the effect of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) on albumin excretion rate (AER) in Type 1 diabetic patients. In a 3-year multicentre retrospective observational study, 110 Type 1 diabetic patients treated with CSII were compared with 110 patients treated with MDI matched at baseline for age, sex, diabetes duration and HbA(1c). At entry, 90 patients in each group had normal AER and 20 persistent microalbuminuria. AER, estimated glomerular filtration rate (eGFR), HbA(1c,) lipids and blood pressure were assessed. HbA(1c) was lower in the CSII than in the MDI group (8.1 +/- 0.9 vs. 8.4 +/- 1.3%; P < 0.005 after 3 years). Blood pressure and eGFR were similar during the study. AER [median (95% confidence interval)], similar at baseline [6.0 microg/min (9, 21) in the CSII group vs. 4.4 (8, 16) in the MDI group, NS] was significantly lower in the patients treated with CSII both at year 2 and at year 3 of follow-up [4.7 microg/min (6, 12) vs. 6.4 (13, 29), P < 0.002]. This difference was observed even when normo- and microalbuminuric patients were analysed separately. Nine patients progressed to microalbuminuria in the MDI group and only one in the CSII group. Nine patients regressed to normoalbuminuria in the CSII group, whereas only two regressed to normoalbuminuria in the MDI group. Despite a small benefit in terms of improved glycaemic control, CSII therapy may be useful in decreasing the progressive increase in AER in Type 1 diabetic patients.
    Diabetic Medicine 06/2009; 26(6):602-8. · 3.24 Impact Factor
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    ABSTRACT: This prospective study evaluated the impact of gestational diabetes on maternal and fetal outcome in a large cohort of women with gestational diabetes mellitus (GDM) followed up using standardized clinical criteria. Between 1999 and 2003, we collected 3465 GDM women from 31 Italian regional obstetric or diabetes centers, recording the time and mode of delivery, gestational hypertension, pre-eclampsia, eclampsia, congenital malformations, and neonatal mortality, comparing findings with the Italian general pregnant population. The rate of cesarean sections was 34.9% and macrosomia 8.7% (33.2 and 7.4%, respectively, in the general population, p=ns). The stillbirth and neonatal mortality rates were no different in GDM patients and normal pregnancies (0.34% vs. 0.30%, p=0.176 and 0.29% vs. 0.32%, p=0.748), but the former had twice as many newborn with congenital malformations (2.05% vs. 0.89%, p<0.01; CI 1.64-2.62). A prognostic model for the outcome of pregnancy was built and the concurrent occurrence of several conditions was deemed as a positive outcome. Pregnancies which did not meet one or more of the above criteria were classified as "complicated". On multivariate logistic analysis, only the week of gestation when GDM was diagnosed and prepregnancy BMI were independent predictors of a complicated pregnancy. When correctly diagnosed and treated during pregnancy, women with GDM have a pregnancy outcome similar to the general pregnant population, except for a greater likelihood of congenital malformations in the newborn, probably due to unrecognized prior diabetes. Prepregnancy obesity plays an important part in raising the risk of adverse perinatal outcomes in GDM patients.
    European journal of obstetrics, gynecology, and reproductive biology 05/2009; 145(2):149-53. · 1.97 Impact Factor
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    ABSTRACT: AimTo verify whether, with thorough practical and theoretical training, well-controlled, non-complicated diabetic patients can safely go diving underwater with no additional medical or metabolic risks.MethodsTwelve diabetic patients participated in the study after undergoing training focused on their diabetic status. Two dives per day were scheduled during two five-day stays on the island of Ventotene (Italy). Capillary blood glucose (BG) was checked at 60, 30 and 10 minutes before diving, and corrective measures adopted if necessary, based on BG absolute levels and dynamics. A device for continuous subcutaneous glucose monitoring (CGM), expressly modified for the purpose, was worn during dives.ResultsData were gathered from 90 dives; mean BG at 60, 30 and 10 minutes before diving was 205.8 ± 69.6 mg/dL, 200.0 ± 66.4 mg/dL and 200.5 ± 61.0 mg/dL, respectively. In 56 of the 90 dives, supplementary carbohydrates or insulin were necessary, but only one dive was interrupted on account of hypoglycaemic symptoms. Mean post-dive BG was 158.9 ± 80.8 mg/dL. CGM recordings showed that glucose levels gradually decreased during the dives (nadir: –19.9%).ConclusionExperienced, well-controlled, complication-free young diabetic patients can safely go scuba diving, provided that they apply a rigorous protocol based on serial pre-dive BG measurements. The specific variables of underwater diving do not appear to involve significant additional risks of hypoglycaemia.RésuméObjectifLe but de cette étude était de vérifier si, après avoir reçu une formation spécifique, de jeunes diabétiques bien équilibrés, sans complications, pouvaient plonger en sécurité, sans risques médicaux et métaboliques supplémentaires.MéthodesDouze jeunes diabétiques de type 1 ont participé à l’étude, après un cours de plongée dont le programme était ciblée sur le diabète. Pendant deux stages de cinq jours sur l’île de Ventotene (Italie), deux plongées par jour ont été programmées. La glycémie capillaire (GC) était mesurée 60, 30, et dix minutes avant la mise à l’eau, et des mesures de correction étaient adoptées en cas de nécessité, en fonction des niveaux absolus de GC et de leur dynamique. Un dispositif portable de mesure en continu du glucose S.C. (CGM), spécialement adapté à cette fin, a été également utilisé en immersion.RésultatsNous avons obtenu les données valides de 90 plongées ; la GC moyenne (GM) mesurée 60, 30 et dix minutes avant immersion était de 205,869,6, 200,066,4, et 200,561,0 mg/dL. Dans 56 plongées sur 90, un apport de glucides ou des injections d’insuline supplémentaires ont été nécessaires. Une seule plongée a dû être interrompue du fait de signes d’hypoglycémie. Après la plongée, nous avons relevé une GC moyenne de 158,980,8 mg/dL. Les résultats du CGM ont montré une diminution modérée et progressive des concentrations de glucose S.C. pendant les plongées (nadir -19,9 %).ConclusionAprès une formation spécifique, et en appliquant rigoureusement un protocole de prévention fondé des contrôles répétés de la GC avant l’immersion, un jeune diabétique expert, bien équilibré, indemnes de complications, peut pratiquer avec un niveau de sécurité raisonnable la plongée avec scaphandre autonome. En particulier, chez ces patients les conditions spécifiques de la plongée ne semblent pas comporter d’augmentation significative du risque d’hypoglycémie.
    Diabetes & Metabolism. 04/2009;
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    ABSTRACT: Insulin glargine (IG), with its non-peaking action profile, might be useful in diabetic pregnancy. However, data on its safety are limited and its use during pregnancy is not recommended. This study focused on the effects of IG on perinatal outcome, particularly to estimate the rate of congenital anomalies and birthweight. This retrospective study included women with pre-gestational diabetes who used IG before (at least 1 month) and during pregnancy. For all women we recorded data regarding maternal glycaemic control and pregnancy outcome. We also compared women treated with IG throughout pregnancy and women who stopped taking IG at an earlier stage. From 27 centres, 107 Type 1 diabetic pregnancies were identified. IG was started 10.3 +/- 6.9 months before conception and in 57.4% of cases was stopped during the first trimester; 42.6% of women continued using it until the end of pregnancy. There were six abortions (four spontaneous and two induced) and five newborns (4.9%) with congenital anomalies. Glycaemic control, birthweight and the prevalence of macrosomia and neonatal morbidity were similar in women who used IG for the full term compared with those who stopped IG earlier during pregnancy. This study, although limited, suggests that IG is safe and effective; the rate of congenital malformations was within the range expected for diabetic pregnancies treated with more traditional forms of insulin. IG used throughout pregnancy did not seem to influence birthweight or increase adverse outcomes.
    Diabetic Medicine 09/2008; 25(8):993-6. · 3.24 Impact Factor
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    ABSTRACT: To determine pregnancy outcome in women with type 1 and type 2 diabetes. A prospective study was conducted in 33 centers in Italy between 1999 and 2003, mainly recording preterm delivery, stillbirths, neonatal mortality, congenital malformations and birthweight. Of the 668 women examined, 504 had type 1 diabetes and 164 had type 2. Pre-pregnancy counseling had been provided to 43.9% of the women who had type 1 diabetes and 29.1% of the women who had type 2 diabetes and correlated with a better HbA1c value throughout pregnancy. The preterm delivery rate was significantly higher in type 1 and 2 diabetics than in normal pregnant women and was related to HbA1c values higher than 8%, gestational hypertension, pre-eclampsia and the presence of retinopathy before pregnancy. The stillbirth and neonatal mortality rates were also higher in diabetic pregnant women (1.26% and 0.63%, respectively) than in Italian pregnancies in general (0.30% and 0.32%), and the same was true for major congenital malformations (4.9% for diabetic pregnancies, 0.86% for normal Italian pregnancies). In our population, pregnancy in diabetic women was still associated with a high rate of stillbirths, neonatal mortality and congenital malformations. Unplanned pregnancies and non-optimal glycemia control may help explain the high rates of maternal and neonatal complications.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 06/2008; 18(4):291-7. · 3.52 Impact Factor
  • Diabetic Medicine 04/2008; 25(3):379-80. · 3.24 Impact Factor
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    ABSTRACT: Some studies have shown that fetal outcome observed in patients using insulin lispro is much the same as in pregnant women using regular insulin. This study aims to analyze the Italian data emerging from a multinational, multicenter, retrospective study on mothers with type 1 diabetes mellitus before pregnancy, comparing those treated with insulin lispro for at least 3 months before and 3 months after conception with those treated with regular insulin. The data collected on pregnant women with diabetes attending 15 Italian centers from 1998 to 2001 included: HbA1c at conception and during the first and third trimesters, frequency of severe hypoglycemic episodes, spontaneous abortions, mode and time of delivery, fetal malformations and mortality. Seventy-two diabetic pregnancies treated with lispro and 298 treated with regular insulin were analyzed, revealing a trend towards fewer hypoglycemic episodes in the former, who also had a significantly greater reduction in HbA1c during the first trimester. The rate of congenital malformations was similar in the offspring of the two groups of women treated with insulin lispro or regular insulin. These findings suggest that insulin lispro could be useful for the treatment of hyperglycemia in type 1 diabetic pregnant women.
    Acta Diabetologica 04/2008; 45(1):61-6. · 4.63 Impact Factor
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    ABSTRACT: To assess whether HbA1c and plasma glucose predicts abnormal fetal growth, 758 pregnant women attending 5 Diabetic Centers were screened for gestational diabetes mellitus (GDM). On glucose challenge (GCT) at 24-27 weeks of gestation (g.w.), negative cases formed the normal control group (N1). Positive cases took an oral glucose tolerance test (OGTT): those found negative were classed as false positives screening test (N2); if they had an OGTT result at least as high as their normal glucose levels, they were classed as having one abnormal glucose value (OAV) at OGTT; two values as GDM. HbA1c was assayed on the day of GCT. We considered fetal macrosomia, large for gestational age (LGA), ponderal index and mean growth percentile. Mean age, pre-pregnancy BMI, fasting plasma glucose (FPG) and HbA1c were progressively higher from N1 to GDM patients. The newborn of N2 mothers were heavier than those with N1 or GDM. The mean growth percentile was significantly higher in N2 than in N1. More LGA babies were born to OAV than to N1 or N2 women. Macrosomia and ponderal index did not differ significantly in the four groups. At logistic regression only plasma glucose at GCT could predict LGA babies and a ponderal index above 2.85. At risk analysis, GDM and OAV significantly predicted LGA babies, and GDM a ponderal index >2.85. In conclusion, FPG at GCT could predict fetal overgrowth and plasma glucose >85mg/dl doubles the risk of LGA infants. HbA1c at 24-27g.w. does not predict fetal overgrowth. Mild alterations in glucose tolerance correlate with fetal overgrowth and needs monitoring and treatment.
    Diabetes Research and Clinical Practice 09/2007; 77(3):465-70. · 2.74 Impact Factor
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    ABSTRACT: The reference intervals for hemoglobin A1c (Hb A1c) in pregnant women without diabetes are not well defined, and few examples of reference intervals established by networks of different laboratories are available. Five Italian Diabetic Care Units were involved in the study. Data were collected from 445 pregnant women without diabetes, selected on the basis of glucose challenge test results, and from 384 nonpregnant control women. The Hb A1c measurements were performed with HPLC systems aligned to the Diabetes Control and Complications Trial. Plasma glucose measurements were also performed locally. Both Hb A1c and glucose measurements were harmonized by running appropriate external quality assessment schemes. The reference intervals were calculated in terms of nonparametric 2.5th to 97.5th percentiles with 0.90 confidence intervals. The Hb A1c measurements were reproducible (CV = 2.0%) and accurate [mean (SE) difference from the target values, -0.10 (0.06)%]. Glucose measurements were also reproducible (mean CV = 3.2%) and accurate [difference from the target values, -0.01 (0.04) mmol/L]. To calculate common reference intervals, we merged the data collected in the different centers. The Hb A1c reference intervals were 4.0%-5.5% for pregnant nondiabetic women and 4.8%-6.2% for nonpregnant controls. Healthy pregnant women have lower Hb A1c concentrations than nonpregnant women. The reference intervals for Hb A1c in pregnant women should therefore be lower than those currently in use.
    Clinical Chemistry 07/2006; 52(6):1138-43. · 7.15 Impact Factor
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    ABSTRACT: Most studies relating minor gestational metabolic alterations to macrosomia refer to glucose intolerance classified on the basis of the National Diabetes Data Group or previous World Health Organization diagnostic thresholds. Our aim was to evaluate the consequences of very mild forms of gestational glucose intolerance, defined by an elevated 50-g glucose challenge test followed by a normal oral glucose tolerance test, using the more restrictive Carpenter and Coustan's criteria (Borderline Gestational Glucose Intolerance, BGGI). Three hundred BGGI women were randomly assigned to: Group A (standard management), Group B (dietary treatment and regular monitoring). A control group (C) was also considered. Newborns were classified as macrosomic, large (LGA), or small for gestational age (SGA). The three groups were similar in age, body mass index and parity. Therapy in Group B significantly improved fasting (from 4.68 +/- 0.45 to 4.28 +/- 0.45 mmol/l) and 2-h postprandial glycaemia (from 6.01 +/- 0.57 to 5.13 +/- 0.68 mmol/l). Fasting glycaemia at delivery was significantly lower in B (4.20 +/- 0.38 mmol/l) than in A (4.84 +/- 0.45 mmol/l), and was also lower than in C (4.31 +/- 0.39 mmol/l). Significantly fewer LGA babies were born to Group B (6.0%) than Group A (14.0%) and Group C (9.1%). No difference was found in the SGA rate. The neonatal Ponderal Index was higher (P = 0.030) in group A (2.73 +/- 0.35) than in C (2.64 +/- 0.30) and B (2.64 +/- 0.24). Even very mild alterations in glucose tolerance can result in excessive or disharmonious fetal growth, which may be prevented by simple, non-invasive therapeutic measures.
    Diabetic Medicine 12/2005; 22(11):1536-41. · 3.24 Impact Factor
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    ABSTRACT: In order to prevent abnormalities of fetal growth still characterizing pregnancies complicated by Gestational Diabetes (GDM), in the present study we evaluated a therapeutic strategy for GDM based on ultrasound (US) measurement of fetal insulin-sensitive tissues. All GDM women diagnosed before 28th week immediately started diet and self-monitoring of blood glucose; after 2 weeks they were randomized to conventional (C) or modified (M) management. In C the glycemic target (GT) was fixed at 90 fasting/120 post-prandial mg/dl; in M GT varied, according to US measurement of the Abdominal Circumference (AC) centile performed every 2 weeks: 80/100 if AC > or =75th, 100/140 if AC<75th. Therapy was tailored to mean fasting (FG) and postprandial glycemia (PPG). Globally, 229 women completed the study, 78 in C, 151 in M. Use of insulin was 16.7% in C, 30.4% in M (total groups), significantly more frequent in M than in C (59.7% vs 15.4%) when considering only women with AC > or =75th c. Mean metabolic data were similar in the 2 groups, but in M a tightly-optimized subgroup, resulting from the lowering of GT due to AC > or =75th, coexisted with a less-controlled one, whose higher GT was justified by AC<75th. Pregnancy outcome was better in M, with lower (p<0.05*) rate of LGA* (7.9% vs 17.9%), SGA (6.0% vs 9.0%) and Macrosomia* (3.3% vs 11.5%). Our data show the value of a flexible US-based approach to the treatment of GDM. This model does not necessarily involve a generalized aggressive treatment, allowing to concentrate therapeutical efforts on a small subgroup of women showing indirect US evidence of fetal hyperinsulinization. Such a selective approach allowed to obtain a near-normalization of fetal growth, with clear advantages on global pregnancy outcome.
    Diabetes & Metabolism 06/2004; 30(3):237-44. · 2.39 Impact Factor
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    ABSTRACT: Our purpose was to examine the validity of 140 mg/dL cutoff value in oral glucose challenge test screening for gestational diabetes mellitus when including in the group to be identified women fulfilling more inclusive Carpenter and Coustan criteria for 100-g oral glucose tolerance testing interpretation and gravid women with borderline glucose intolerance. We reanalyzed data of a multicenter study performed on 704 pregnant women screened at the twenty-fourth to twenty-eighth week with a 50-g oral glucose challenge test followed by a universal 100-g oral glucose tolerance test. We used receiver-operator characteristic curve analysis, assembling positive and negative groups according to the different criteria adopted in oral glucose tolerance test interpretation (National Diabetes Data Group or Carpenter-Coustan) and in assignment of women with borderline glucose intolerance. Besides the statistical cutoff value, defined by the Youden index (Sensitivity + Specificity - 1), we also selected a "high-sensitivity" cutoff value, identified by the maximal sensitivity associated with >70% specificity. With use of National Diabetes Data Group criteria, the statistical and high-sensitivity cutoff values were set at 142 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance. With use of Carpenter-Coustan criteria, the statistical cutoff value was set at 141 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance; the high-sensitivity cutoff value was set at 140 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 136 mg/dL when it also included subjects with borderline glucose intolerance. We suggest maintaining the 140 mg/dL oral glucose challenge test threshold if the diagnostic target is to recognize only women with positive results of the oral glucose tolerance test. To prevent perinatal risks in pregnancies complicated by borderline glucose intolerance, with Carpenter-Coustan criteria a lower cutoff value (136 mg/dL) could be hypothesized to improve test sensitivity, allowing more extensive diagnosis of "borderline" subjects; however, the higher economic costs resulting from the increased false-positive rate and the limited improvement obtainable in sensitivity currently do not justify its generalized use.
    American Journal of Obstetrics and Gynecology 07/1998; 179(1):179-85. · 3.88 Impact Factor
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    ABSTRACT: OBJECTIVE: Our purpose was to examine the validity of 140 mg/dL cutoff value in oral glucose challenge test screening for gestational diabetes mellitus when including in the group to be identified women fulfilling more inclusive Carpenter and Coustan criteria for 100-g oral glucose tolerance testing interpretation and gravid women with borderline glucose intolerance.STUDY DESIGN: We reanalyzed data of a multicenter study performed on 704 pregnant women screened at the twenty-fourth to twenty-eighth week with a 50-g oral glucose challenge test followed by a universal 100-g oral glucose tolerance test. We used receiver-operator characteristic curve analysis, assembling positive and negative groups according to the different criteria adopted in oral glucose tolerance test interpretation (National Diabetes Data Group or Carpenter-Coustan) and in assignment of women with borderline glucose intolerance. Besides the statistical cutoff value, defined by the Youden index (Sensitivity + Specificity – 1), we also selected a “high-sensitivity” cutoff value, identified by the maximal sensitivity associated with >70% specificity.RESULTS: With use of National Diabetes Data Group criteria, the statistical and high-sensitivity cutoff values were set at 142 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance. With use of Carpenter-Coustan criteria, the statistical cutoff value was set at 141 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance; the high-sensitivity cutoff value was set at 140 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 136 mg/dL when it also included subjects with borderline glucose intolerance.CONCLUSIONS: We suggest maintaining the 140 mg/dL oral glucose challenge test threshold if the diagnostic target is to recognize only women with positive results of the oral glucose tolerance test. To prevent perinatal risks in pregnancies complicated by borderline glucose intolerance, with Carpenter-Coustan criteria a lower cutoff value (136 mg/dL) could be hypothesized to improve test sensitivity, allowing more extensive diagnosis of “borderline” subjects; however, the higher economic costs resulting from the increased false-positive rate and the limited improvement obtainable in sensitivity currently do not justify its generalized use. (Am J Obstet Gynecol 1998;179:179-85.)
    American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/1998; 179(1):179-185.
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    ABSTRACT: We examined the pregnancy outcome of 112 women classified as minor degrees of glucose intolerance (MDGI) in pregnancy in a screening program based on Carpenter and Coustan's criteria. The MDGI group comprised 49 women with abnormal oral glucose challenge test (OGCT) followed by normal OGTT (group A), and 63 with "borderline" OGTT (1 abnormal value, group B). No treatment was offered to 88 MDGI women, while 26 received dietary advice and metabolic monitoring. A control group was constituted from 112 age- and BMI-matched negative screenees. Similar rates of cesarean sections and macrosomia, but higher rate of large for gestational age (LGA) babies (25.9% vs 14.3%) were found in MDGI, without difference between groups A and B. When comparing treated and untreated MDGI, lower LGA incidence (11.5% vs 30.2%) and no macrosomia were found in the former. In conclusion, untreated MDGI may present excessive fetal growth, which can be normalized by dietary treatment and metabolic monitoring.
    Annali dell'Istituto superiore di sanita 01/1997; 33(3):393-7. · 0.76 Impact Factor
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    ABSTRACT: In order to evaluate the interference of prolactin (PRL) on some aspects of pituitary-gonadal derangement observed in patients with hyperprolactinaemic amenorrhoea (HA), a GnRH stimulation test (100 micrograms i.v.) was performed on twenty-one patients with hyperprolactinaemia without evidence of pituitary tumour and in nine subjects with Turner's syndrome (TS) before and after sulpiride administration (200 mg/day orally, for 3 months). In patients with HA an enhanced response of gonadotrophins to GnRH was observed. In patients with TS a further increase of the gonadotrophin hyper-responsiveness to the releasing hormone occurred when hyperprolactinaemia was induced by chronic sulpiride administration. Since, in these patients, appreciable ovarian steroidogenesis is lacking, a direct effect of the increased plasma PRL at the hypothalamo-pituitary level is likely. In hyperprolactinaemic amenorrhoea pituitary hyper-responsiveness may not be due to PRL effects on ovarian steroidogenesis.
    Clinical Endocrinology 08/1980; 13(1):9-16. · 3.40 Impact Factor
  • Panminerva medica 22(2):61-71. · 2.28 Impact Factor