The National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Randomized Clinical Trial in Progress A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors A Medical Nutrition Therapy Program Improves Perinatal Outcomes in Mexican Pregnant Women With Gestational Diabetes and Type 2 Diabetes Mellitus The Impact of Self-Monitoring of Blood Olucose on Self-Efficacy and Pregnancy Outcomes in Women With Diet-Controlled Gestational Diabetes Glycemic index of foods: a physiological basis for carbohydrate exchange. Physical activity and gestational diabetes mellitus among Hispanic women. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial. Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial 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. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study Costs and consequences of treatment for mild gestational diabetes mellitus – evaluation from the ACHOIS randomised trial Metformin in Gestational Diabetes: The Offspring Follow-Up (MiG TOFU) Borderline gestational diabetes mellitus and pregnancy outcomes Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study Effect of Treatment of Gestational Diabetes Mellitus on Obesity in the Next Generation Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Effect of Acupressure on Maternal Anxiety in Women With Gestational Diabetes Mellitus Metformin compared with glyburide for the management of gestational diabetes. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Comparison of the effect of saturated and monounsaturated fat on postprandial plasma glucose and insulin concentration in women with gestational diabetes mellitus. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Fetal male gender and the benefits of treatment of mild gestational diabetes mellitus. Usefulness of a Breakfast Test in the Management of Women With Gestational Diabetes Insulin Treatment and High Risk Groups Pharmaceutical care of patients with gestational diabetes mellitus. A randomised controlled pilot study of the management of gestational impaired glucose tolerance Advice that includes food sources of unsaturated fat supports future risk management of gestational diabetes mellitus. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. Investigating the effects of treatment based on single high blood glucose in gestational diabetes screening on maternal and neonatal complications Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus. The Potential Diabetic and Her Treatment in Pregnancy A prospective study of pregravid determinants of gestational diabetes mellitus. Medical Treatment of the Gestational Diabetic Treatment of women with an abnormal glucose challenge test (but a normal oral glucose tolerance test) decreases the prevalence of macrosomia. Gestational diabetes mellitus (GDM) diagnosis, therapy and follow-up care: Practice Guideline of the German Diabetes Association(DDG) and the German Association for Gynaecologyand Obstetrics (DGGG). Erratum to: a randomised translational trial of lifestyle intervention using a 3-tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes Glycemic Characteristics and Neonatal Outcomes of Women Treated for Mild Gestational Diabetes The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. A community-based parish nurse intervention program for Mexican American women with gestational diabetes. Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. A planned randomized clinical trial of treatment for mild gestational diabetes mellitus Does maternal body mass index influence treatment effect in women with mild gestational diabetes? Effect of Treatment of Mild Gestational Diabetes on Long-Term Maternal Outcomes. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial A multicenter, randomized trial of treatment for mild gestational diabetes. Comprehensive intensive therapy for Chinese gestational diabetes benefits both newborns and mothers. The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut‐off criteria for abnormal glucose tolerance
It is recognized that women with gestational diabetes mellitus ( GDM ) who have significantly elevated fasting blood glucose levels are at increased risk for fetal macrosomia and perinatal morbidity if treatment is not provided ( 1,2 ) . The association of milder forms of GDM with perinatal morbidity and mortality remains unclear , primarily because the condition is often confounded with other risk factors such as maternal obesity , age , and parity . Screening for GDM is recommended for most pregnant women , yet it is unknown whether there is a benefit to the identification and treatment of mild carbohydrate intolerance during pregnancy ( 3,4 ) . The present report is an up date of our previous description of a current ongoing r and omized treatment trial for mild GDM ( 5 ) . A r and omized clinical trial of women with mild GDM ( fasting glucose < 95 mg/dl ) is being undertaken that compares perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . This study aims to clarify whether there is utility in identifying and treating women with a normal fasting glucose level who meet st and ard criteria for GDM . We plan to compare perinatal outcomes in women who have been r and omized to diet and /or insulin therapy with women who have been r and omized to no specific treatment . A r and omized treatment trial of mild GDM will clarify whether identification and treatment of mild GDM reduce perinatal morbidity . This information will assist in determining appropriate thresholds for the treatment of GDM . Overall , with broader identification and aggressive treatment , perinatal mortality rates associated with GDM appear to be similar to the nondiabetic population ( 1 ) . Several analyses of 20 years ago did document an increased stillbirth rate for GDM pregnancies that would qualify as preexisting diabetes according to World Health Organization criteria ( 6–9 ) . Below this threshold , the extent to OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy PURPOSE The purpose of this study was to examine the effects of self-monitoring of blood glucose ( SMBG ) on feelings of self-efficacy , dietary compliance , and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus ( GDM ) . METHODS Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were r and omly assigned to 2 groups . The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory . Metabolic status  was assessed in the control group by periodic monitoring at prenatal visits . Otherwise the management protocol was identical for both groups . The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy .  Dietary compliance was assessed at each visit . RESULTS Both groups of women achieved excellent glucose control ; only 1 woman in each group required insulin therapy . There were no significant differences with regard to feelings of self-efficacy , dietary compliance , birth weight , gestational age at delivery , Apgar scores , and neonatal complications . Rates of macrosomia , delivery by cesarean section , and occurrence of birth trauma were similar . CONCLUSIONS SMBG appears to have little effect on maternal feelings of self-efficacy , dietary compliance , or pregnancy outcomes in women with diet-controlled GDM The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population BACKGROUND The fetuses of women with gestational diabetes mellitus are at risk for macrosomia and its attendant complications . The best method of achieving euglycemia in these women and reducing morbidity in their infants is not known . We compared the efficacy of postpr and ial and prepr and ial monitoring in achieving glycemic control in women with gestational diabetes . METHODS We studied 66 women with gestational diabetes mellitus who required insulin therapy at 30 weeks of gestation or earlier . The women were r and omly assigned to have their diabetes managed according to the results of prepr and ial monitoring or postpr and ial monitoring ( one hour after meals ) of blood glucose concentrations . Both groups were also monitored with  fasting blood glucose measurements . The goal of insulin therapy was a prepr and ial value of 60 to 105 mg per deciliter ( 3.3 to 5.9 mmol per liter ) or a postpr and ial value of less than 140 mg per deciliter ( 7.8 mmol per liter ) . Obstetrical data and information on neonatal outcomes were collected . RESULTS The prepregnancy weight , weight gain during pregnancy , gestational age at the diagnosis of diabetes and at delivery , degree of compliance with therapy , and degree of achievement of target blood glucose concentrations were similar in the two groups . The mean ( + /- SD ) change in the glycosylated hemoglobin value was greater in the group in which postpr and ial measurements were used ( -3.0 + /- 2.2 percent vs. 0.6 + /- 1.6 percent , P < 0.001 ) and the infants ' birth weight was lower ( 3469 + /- 668 vs. 3848 + /- 434 g , P = 0.01 ) . Similarly , the infants born to the women in the postpr and ial-monitoring group had a lower rate of neonatal hypoglycemia ( 3 percent vs. 21 percent , P = 0.05 ) , were less often large for gestational age ( 12 percent vs. 42 percent , P = 0.01 ) and were less often delivered by cesarean section because of cephalopelvic disproportion ( 12 percent vs. 36 percent , P = 0.04 ) than those in the prepr and ial-monitoring group . CONCLUSIONS Adjustment of insulin therapy in women with gestational diabetes according to the results of postpr and ial , rather than prepr and ial , blood glucose values improves glycemic control and decreases the risk of neonatal hypoglycemia , macrosomia , and cesarean delivery The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower , money and patients ' time Background Mild gestational diabetes is a common complication of pregnancy , affecting up to 9 % of pregnant women . Treatment of mild GDM is known to reduce adverse perinatal outcomes such as macrosomia and associated birth injuries , such as shoulder dystocia , bone fractures and nerve palsies . This study aim ed to compare the plasma glucose concentrations and serum insulin , leptin and adiponectin in cord blood of babies of women ( a ) without gestational diabetes mellitus ( GDM ) , ( b ) with mild GDM under routine care , or ( c ) mild GDM with treatment . Methods 95 women with mild GDM on oral glucose tolerance testing ( OGTT ) at one tertiary level maternity hospital who had been recruited to the ACHOIS trial at one of the collaborating hospitals and r and omised to either Treatment ( n = 46 ) or Routine Care ( n = 49 ) and Control women with a normal OGTT ( n = 133 ) were included in the study . Women with mild GDM ( treatment or routine care group ) and OGTT normal women received routine pregnancy care . In addition , women with treated mild GDM received dietary advice , blood glucose monitoring and insulin if necessary . The primary outcome measures were cord blood concentrations of glucose , insulin , adiponectin and leptin . Results Cord plasma glucose was higher in women receiving routine care compared with control , but was normalized by treatment for mild GDM ( p = 0.01 ) . Cord serum insulin and insulin to glucose ratio were similar between the three groups . Leptin concentration in cord serum was lower in GDM treated women compared with routine care ( p = 0.02 ) and not different to control ( p = 0.11 ) . Adiponectin was lower in both mild GDM groups compared with control ( Treatment p = 0.02 and Routine Care p = 0.07 ) , while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment ( p = 0.08 ) and control ( p = 0.05 ) . Conclusion Treatment of women with mild GDM using diet , blood glucose monitoring and insulin if necessary , influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy 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 detecting any major adverse outcomes in the control group that received routine obstetric care . STUDY DESIGN The study was a prospect i ve r and omized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes . Women r and omized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care , and women in the control arm received routine obstetric care . RESULTS Three hundred women with gestational diabetes mellitus were studied . There was no difference in maternal age , weight , or length of gestation between groups . The treatment mean birth weight was 3437 + /- 575 gm compared with 3544 + /- 601 gm in the control group , a difference of 107 gm ( not significant ) . Macrosomia rates were similar . There was no birth trauma in either group . The frequency of neonatal hypoglycemia and other metabolic complications was the same . The mode of delivery also showed similar patterns . The treatment group had significantly lower prepr and ial and postpr and ial glucose levels by 32 weeks ' gestation , which continued to term . CONCLUSION This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight , birth trauma , operative delivery , or neonatal metabolic disorders . It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria ( IADPSGC ) for the diagnosis of gestational diabetes mellitus ( GDM ) results in an increased prevalence of GDM . Whether their introduction improves pregnancy outcomes has yet to be established . We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan ( CC ) criteria . RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospect ively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation . Both groups received the same treatment and follow-up regimes . RESULTS The use of IADPSGC result ed in an important increase in GDM rate ( 35.5 % vs. 10.6 % ) and an improvement in pregnancy outcomes , with a decrease in the rate of gestational hypertension ( 4.1 to 3.5 % : −14.6 % , P < 0.021 ) , prematurity ( 6.4 to 5.7 % : −10.9 % , P < 0.039 ) , cesarean section ( 25.4 to 19.7 % : −23.9 % , P < 0.002 ) , small for gestational age ( 7.7 to 7.1 % : −6.5 % , P < 0.042 ) , large for gestational age ( 4.6 to 3.7 % : −20 % , P < 0.004 ) , Apgar 1-min score < 7 ( 3.8 to 3.5 % : −9 % , P < 0.015 ) , and admission to neonatal intensive care unit ( 8.2 to 6.2 % : −24.4 % , P < 0.001 ) . Estimated cost savings was of € 14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC . CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population , as well as significant improvements in pregnancy outcomes , and was cost-effective . Our results support their adoption Background Recommended best practice is that economic evaluation of health care interventions should be integral with r and omised 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 r and omised clinical trial . Methods Women with a singleton pregnancy who had mild gestational diabetes diagnosed by an oral glucose-tolerance test between 24 and 34 weeks ' gestation and their infants were included . Clinical outcomes and outpatient costs derived from all women and infants in the trial . Inpatient costs derived from women and infants attending the hospital contributing the largest number of enrolments ( 26.1 % ) , and charges to women and their families derived from a sub sample of participants from that hospital ( in 2002 Australian dollars ) . Occasions of service and health outcomes were adjusted for maternal age , ethnicity and parity . Analysis of variance was used with bootstrapping to confirm results . Primary clinical outcomes were serious perinatal complications ; admission to neonatal nursery ; jaundice requiring phototherapy ; induction of labour and caesarean delivery . Economic outcome measures were outpatient and inpatient costs , and charges to women and their families . Results For every 100 women with a singleton pregnancy and positive oral glucose tolerance test who were offered treatment for mild gestational diabetes mellitus in addition to routine obstetric care , $ 53,985 additional direct costs were incurred at the obstetric hospital , $ 6,521 additional charges were incurred by women and their families , 9.7 additional women experienced induction of labour , and 8.6 more babies were admitted to a neonatal nursery . However , 2.2 fewer babies experienced serious perinatal complication and 1.0 fewer babies experienced perinatal death . The incremental cost per additional serious perinatal complication prevented was $ 27,503 , per perinatal death prevented was $ 60,506 and per discounted life-year gained was $ 2,988 . Conclusion It is likely that the general public in high-income countries such as Australia would find reductions in perinatal mortality and in serious perinatal complications sufficient to justify additional health service and personal monetary charges . Over the whole lifespan , the incremental cost per extra life-year gained is highly favourable . Trial Registration Australian Clinical Trials Registry OBJECTIVE In women with gestational diabetes mellitus , who were r and omized to metformin or insulin treatment , pregnancy outcomes were similar ( Metformin in Gestational diabetes [ MiG ] trial ) . Metformin crosses the placenta , so it is important to assess potential effects on growth of the children . RESEARCH DESIGN AND METHODS In Auckl and , New Zeal and , and Adelaide , Australia , women who had participated in the MiG trial were review ed when their children were 2 years old .  Body composition was measured in 154 and 164 children whose mothers had been r and omized to metformin and insulin , respectively . Children were assessed with anthropometry , bioimpedance , and dual energy X-ray absorptiometry ( DEXA ) , using st and ard methods . RESULTS The children were similar for baseline maternal characteristics and pregnancy outcomes . In the metformin group , compared with the insulin group , children had larger mid-upper arm circumferences ( 17.2 ± 1.5 vs. 16.7 ± 1.5 cm ; P = 0.002 ) and subscapular ( 6.3 ± 1.9 vs. 6.0 ± 1.7 mm ; P = 0.02 ) and biceps skinfolds ( 6.03 ± 1.9 vs. 5.6 ± 1.7 mm ; P = 0.04 ) . Total fat mass and percentage body fat assessed by bioimpedance ( n = 221 ) and DEXA ( n = 114 ) were not different . CONCLUSIONS Children exposed to metformin had larger measures of subcutaneous fat , but overall body fat was the same as in children whose mothers were treated with insulin alone . Further follow-up is required to examine whether these findings persist into later life and whether children exposed to metformin will develop less visceral fat and be more insulin sensitive . If so , this would have significant implication s for the current p and emic of diabetes Background The impact of borderline gestational diabetes mellitus ( BGDM ) , defined as a positive oral glucose challenge test ( OGCT ) and normal oral glucose tolerance test ( OGTT ) , on maternal and infant health is unclear . We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes . Methods We compared demographic , obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia ( ACTS ) who had BGDM and who screened negative on OGCT . Results Women who had BGDM were older ( mean difference 1.3 years , [ 95 % confidence interval ( CI ) 0.3 , 2.2 ] , p = 0.01 ) and more likely to be  obese  ( 27.1 % vs 14.1 % , relative risk ( RR ) 1.92 , [ 95 % CI 1.41 , 2.62 ] , p < 0.0001 ) than women who screened negative on OGCT . The risk of adverse maternal outcome overall was higher ( 12.9 % vs 8.1 % , RR 1.59 , [ 95 % CI 1.00 , 2.52 ] , p = 0.05 ) in women with BGDM compared with women with a normal OGCT . Women with BGDM were more likely to develop pregnancy induced hypertension ( 17.9 % vs 11.8 % , RR 1.51 , [ 95 % CI 1.03 , 2.20 ] , p = 0.03 ) , have a caesarean for fetal distress ( 17.1 % vs 10.5 % , RR 1.63 , [ 95 % CI 1.10 , 2.41 ] , p = 0.01 ) , and require a longer postnatal hospital stay ( mean difference 0.4 day , [ 95 % CI 0.1 , 0.7 ] , p = 0.01 ) than those with a normal glucose tolerance . Infants born to BGDM mothers were more likely to be born preterm ( 10.7 % vs 6.4 % , RR 1.68 , [ 95 % CI 1.00 , 2.80 ] , p = 0.05 ) , have macrosomia ( birthweight ≥4.5 kg ) ( 4.3 % vs 1.7 % , RR 2.53 , [ 95 % CI 1.06 , 6.03 ] , p = 0.04 ) , be admitted to the neonatal intensive care unit ( NICU ) ( 6.5 % vs 3.0 % , RR 2.18 , [ 95 % CI 1.09 , 4.36 ] , p = 0.03 ) or the neonatal nursery ( 40.3 % vs 28.4 % , RR 1.42 , [ 95 % CI 1.14 , 1.76 ] , p = 0.002 ) , and have a longer hospital stay ( p = 0.001 ) . More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy ( 12.9 % vs 7.8 % , RR 1.65 , [ 95 % CI 1.04 , 2.63 ] , p = 0.03 ) . Conclusion Women with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT . Intervention strategies to reduce the risks for these women and their infants need evaluation . Trial registration Current Controlled Trials IS RCT Background Women who are diagnosed with gestational diabetes mellitus ( GDM ) are at increased risk for developing prediabetes and type 2 diabetes mellitus ( T2DM ) . To date , there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM . This paper describes the rationale , design and methodology of a 2-year , r and omized , controlled study being conducted in North Carolina . Methods / Design Using a two-group , repeated measures , experimental design , we will test a 14- week intensive intervention on the benefits of breastfeeding , underst and ing gestational diabetes and risk of progression to prediabetes and T2DM , nutrition and exercise education , coping skills training , physical activity ( Phase I ) , educational and motivational text messaging and 3 months of continued monthly contact ( Phase II ) . A total of 100 African American , non-Hispanic white , and bilingual Hispanic women between 22–36 weeks of pregnancy who are diagnosed with GDM and their infants will be r and omized to either the experimental group or the wait-listed control group . The first aim of the study is to determine the feasibility of the intervention . The second aim of study is to test the effects of the intervention on maternal outcomes from baseline ( 22–36 weeks pregnant ) to 10 months postpartum . Primary maternal outcomes will include fasting blood glucose and weight ( BMI ) from baseline to 10 months postpartum . Secondary maternal outcomes will include clinical , adiposity , health behaviors and self-efficacy outcomes from baseline to 10 months postpartum . The third aim of the study is to quantify the effects of the intervention on infant feeding and growth . Infant outcomes will include weight status and breastfeeding from birth through 10 months of age . Data analysis will include general linear mixed-effects models . Safety endpoints include adverse event reporting . Discussion Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory , reducing the burden of metabolic disease across two generations . Trial registration 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 r and omized 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 st and ards 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 We studied the impact of a training program on glucose tolerance in gestational diabetes mellitus . Women with gestational diabetes mellitus ( N = 19 ) were r and omized into either group I , a 6-week diet alone group ( 24 to 30 kcal/kg/24 hours ; 20 % protein , 40 % carbohydrate , 40 % fat ) , or group II , which followed the same diet plus exercise ( 20 minutes three times a week for 6 weeks ) . An arm ergometer was used to maintain heart rate in the training range . Glycemic response was monitored by glycosylated hemoglobin , a 50 gm oral glucose challenge with a fasting and 1-hour plasma glucose , and blood glucose self-monitoring , fasting and 1 hour  after meals .  Week 1 glycemic parameters were the same for both groups . Week 6 data ( mean + /- SD ) were as follows : group I glycosylated hemoglobin , 4.7 % + 0.2 % versus group II , 4.2 % + /- 0.2 % ; p less than 0.001 . The group I glucose challenge fasting value was 87.6 + /- 6.2 versus 70.1 + /- 6.6 mg/dl , p less than 0.001 for group II . The group I 1-hour plasma glucose challenge result was 187.5 + /- 12.9 mg/dl versus 105.9 + /- 18.9 mg/dl for group II , p less than 0.001 . The glycemic levels diverged between the groups at week 4 . We conclude that arm ergometer training is feasible in women with gestational diabetes mellitus and results in lower glycosylated hemoglobin , fasting , and 1-hour plasma glucose concentrations than diet alone . Arm ergometer training may provide a useful treatment option for women with gestational diabetes mellitus and may obviate insulin treatment Women with diabetes often experience a higher level of anxiety . The aim of the study was to evaluate the effect of acupressure on relieving anxiety of women with gestational diabetes mellitus ( GDM ) . A r and omized clinical trial was conducted on 60 women with GDM at a university hospital . The participants were allocated to an experimental and a placebo group ( 30 women per group ) . The experimental group received a nurse-provided acupressure at the true point , and the placebo group received pressure ( touching ) at a sham ( false ) point . Anxiety was measured immediately in the groups prior to and after a 2-day intervention by a question naire and the Visual Analogue Scale . The data were analyzed using descriptive and inferential statistics . Results indicated that the acupressure group had significantly lower anxiety than the placebo group ( p ≤ .0001 ) . In conclusion , the effects of acupressure appeared to be effective in reducing anxiety  in diabetic pregnant women OBJECTIVE To assess blood glucose control and neonatal outcomes when women with gestational diabetes mellitus ( GDM ) were treated with metformin or glyburide . METHODS When an appropriate diet was insufficient to control their blood glucose levels , women with GDM were r and omized to a glyburide or a metformin treatment group . If the maximum dose was reached , the assessed drug was replaced by insulin . The primary outcome measures analyzed were maternal glucose levels during pregnancy , birth weight , and neonatal glucose levels . RESULTS The only significant difference in outcome between the 2 treatment drugs was that maternal weight gain during pregnancy was less in the metformin ( n=40 ) than in the glyburide group ( n=32 ) ( 10.3 kg vs 7.6 kg ; P=0.02 ) . No differences were found in treatment failure , mean level of fasting or postpr and ial plasma glucose , rate of participants with glycated hemoglobin , birth weight , rate of large-for-gestational-age newborns , or newborns with hypoglycemia . CONCLUSION The treatment of GDM with metformin or glyburide was found to be equivalent for both women and newborns BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects The goal of this study was to determine whether the type of fat plays a role in the glucose response to a meal , independent of the carbohydrate content . Ten gestational diabetic women ( gestational weeks 29 - 34 ) who were well controlled on diet alone were r and omized as to the order in which they would eat a meal , after overnight fast , containing saturated fat ( SF ) or monounsaturated fat ( MUFA ) . Blood was drawn at 0 , 60 , 120 , and 180 min for plasma glucose , insulin , lipid profile ( triglycerides , total cholesterol , HDL-cholesterol , LDL-cholesterol , VLDL-cholesterol ) and free fatty acids . After 2 weeks , each patient received the other type of meal . The test meal was composed of 20 % of the total daily caloric needs based on ideal body weight . The area under the curve showed a significantly lower glucose concentration for SF meal ( p = 0.001 ) . Serum insulin concentrations followed the glucose response with the peak at the 60-min time point and a significantly lower concentration at the 180-min time point in the SF than in the MUFA group . The present study demonstrated that the addition of SF to the meal result ed in lower postpr and ial glucose and insulin than when the meal contained MUFA . Thus , SF may be useful in controlling postpr and ial glucose In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome .  One hundred twenty-six women with one abnormal oral glucose tolerance test value and 146 women in the control group ( normal oral glucose tolerance test values ) participated in a prospect i ve study during the third trimester of pregnancy . The subjects with one abnormal test result were r and omized into treated ( group 1 ) and untreated groups ( group II ) . Group 1 subjects were treated with a strict diabetic protocol to maintain tight glycemic control by means of diet and insulin therapy . Group 2 subjects tested their capillary blood glucose for a baseline period . The study revealed that the level of glycemic control was similar before initiation of therapy ( mean capillary blood glucose 118 + /- 14 vs. 119 + /- 15 mg/dl , p = NS ) for groups 1 and 2 , respectively . There was a significant difference in mean capillary blood glucose ( 95 + /- 10 vs. 119 + /- 15 mg/dl , p less than 0.0001 ) , prepr and ial , and postpr and ial determinations between the treated and untreated groups . The overall incidence of neonatal metabolic complications ( 4 % vs. 14 % , p less than 0.05 ) and large infants ( 6 % vs. 24 % , p less than 0.03 ) was significantly lower in the treated group . Comparison between the control ( normal oral glucose tolerance test ) and the untreated groups showed a significantly higher incidence of large infants and metabolic complications . No difference was found between the normal and treated groups . Thus we conclude that treatment of individuals with one abnormal oral glucose tolerance test value will result in significant reduction in adverse outcome in pregnancy OBJECTIVE We evaluated whether improvements in pregnancy outcomes after treatment of mild gestational diabetes mellitus differed in magnitude on the basis of fetal gender . STUDY DESIGN This is a secondary analysis of a masked r and omized controlled trial of treatment for mild gestational diabetes mellitus . The results included preeclampsia or gestational hypertension , birthweight , neonatal fat mass , and composite adverse outcomes for both neonate ( preterm birth , small for gestational age , or neonatal intensive care unit admission ) and mother ( labor induction , cesarean delivery , preeclampsia , or gestational hypertension ) . After stratification according to fetal gender , the interaction of gender with treatment status was estimated for these outcomes . RESULTS Of the 469 pregnancies with male fetuses , 244 pregnancies were assigned r and omly to treatment , and 225 pregnancies were assigned r and omly to routine care . Of the 463 pregnancies with female fetuses , 233 pregnancies were assigned r and omly to treatment , and 230 pregnancies were assigned r and omly to routine care . The interaction of gender with treatment status was significant for fat mass ( P = .04 ) and birthweight percentile ( P = .02 ) . Among women who were assigned to the treatment group , male offspring were significantly more likely to have both a lower birthweight percentile ( 50.7 ± 29.2 vs 62.5 ± 30.2 percentile ; P < .0001 ) and less neonatal fat mass ( 487 ± 229.6 g vs 416.6 ± 172.8 g ; P = .0005 , ) whereas these differences were not significant among female offspring . There was no interaction between fetal gender and treatment group with regard to other outcomes . CONCLUSION The magnitude of the reduction of a newborn 's birthweight percentile and neonatal fat mass that were related to the treatment of mild gestational diabetes mellitus appears greater for male neonates Objective To assess the usefulness of a breakfast test in determining which women with gestational diabetes do not need self-monitoring of  blood glucose levels ( home monitoring ) . Methods a 1-hour post-st and ardized breakfast blood glucose below 7.8 mmol/L ( 140 mg/dL ) was measured in 227 women and at or above 7.8 mmol/L in 115 . Within each group , women were r and omized to home monitoring with a meter or to clinic follow-up . Target glucose values were 5.3 mmol/L ( 95 mg/dL ) fasting , 5.6 mmol/L ( 101 mg/dL ) before meals , and 7.8 mmol/L ( 140 mg/dL ) 1 hour postpr and ial . Up to these thresholds women on clinic follow-up were transferred to home monitoring . Insulin therapy was started on the same thresholds in women r and omized or transferred to home monitoring .  Large ofr gestational age ( LGA ) newborns  represented the main outcome , with the transfer rate to home monitoring and need of insulin therapy the secondary ones . Results The LGA delivery rate was not significantly different in the two follow-up groups in women with a breakfast result below 7.8 mmol/L ( 9.8 versus 4.3 % ) but was higher in the clinic follow-up among women with a breakfast result at or above 7.8 mmol/L ( 13.3 % versus 30.9 % ; P < .05 ) . Fewer women with a breakfast result below 7.8 mmol/L were transferred to home monitoring ( 2.6 versus 52.7 % ; P < .001 ) or started on insulin therapy ( 3.6 versus 25.2 % ; P < .001 ) . The breakfast test cutoff of 7.8 mmol/L predicted insulin need with a sensitivity of 91.0 % and a specificity of 72.0 % . Conclusion A breakfast test is useful in identifying a low-risk population in which clinic follow-up may be used safely A 16-yr prospect i ve study of 615 gestational diabetic subjects , half of whom were r and omly assigned to insulin therapy during pregnancy , is evaluated to report on the potential reduction in subsequent diabetes due to insulin therapy . No such difference in incidence rates was observed between the two groups . In the subsets of women managed with insulin who bore a baby of large birthweight or who had a family history of diabetes , subsequent decompensated diabetes was found to be significantly reduced . Both life table and multivariate analyses to adjust for the effects of age , weight , level of blood glucose at selection , duration of follow-up , and other potentially confounding covariables confirmed this conclusion . The finding suggests the possibility of long-term preventive benefits from insulin treatment in high risk subsets of women with gestational diabetes RATIONALE , AIMS AND OBJECTIVE To investigate whether the introduction of a programme of optimising drug treatment , intensive education and self-monitoring of patients diagnosed with gestational diabetes mellitus ( GDM ) at an early stage ( < 20 gestational weeks ) , will improve management outcomes as determined by objective measures of patient knowledge about diabetes , glycaemia control , maternal/neonatal complications , and health-related quality of life . METHODS The study was a r and omized , controlled , longitudinal , prospect i ve clinical trial performed at Al-Ain Hospital , Al-Ain , United Arab Emirates . Over an 18-month period , patients diagnosed with GDM were recruited and were r and omly assigned to either an intervention or a control group , in a ratio of 3:2 . Intervention patients received a structured pharmaceutical care service ( including education and introduction of intensive self-monitoring ) while control patients received traditional services . Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics . A range of clinical and humanistic outcome measures , including maternal and neonatal complications , were used to assess the impact of the intervention . RESULTS A total of 165 patients ( 99 intervention , 66 control ) completed the study . The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients . Statistically significant ( P < 0.05 ) improvements were shown in the intervention group for knowledge of diabetes , health-related quality of life ( as determined by the SF36 ) , control of plasma glucose and HbA(1c ) , maternal complications [ e.g. decreased incidence of pre-eclampsia ( 5.1 % vs. 16.7 % ) , eclampsia ( 1.0 % vs. 7.6 % ) , episodes of severe hyperglycaemia ( 3.0 % vs. 19.7 % ) and need for Caesarean section ( 7.1 % vs. 18.2 % ) ] , and neonatal complications [ e.g. decreased incidence of neonatal hypoglycaemia ( 2.0 % vs. 10.6 % ) , respiratory distress at birth ( 4.0 % vs. 15.2 % ) , hyperbilirubinaemia ( 1.0 % vs. 12.1 % ) and large for gestational age ( 9.0 % vs. 22.7 % ) ] . CONCLUSION The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes Objective To determine whether a study of a less intensive form of management for impaired glucose tolerance in pregnancy is feasible and whether women would accept r and omisation Abstract 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 of unsaturated fats , but food advice needs to target this outcome . The aim of this study was to compare the  dietary intakes  of women with GDM given general low-fat advice ( control group )  to women with GDM given the same advice with additional targets for food sources of unsaturated fats ( intervention group ) . After approximately 6 weeks , the intervention group reported more ideal dietary fatty acid intakes than the control group , with polyunsaturated : saturated fat ratios of 1:1 and 0.4:1 , respectively ( P < .001 ) , assessed using repeated measures analysis of variance . These results confirm the need to include food sources of unsaturated fats in advice strategies to assure optimal protective eating habits in this at-risk group AIM The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index ( GI ) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy . METHODS participants , recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population , were r and omized to a low-GI ( n=23 ) or control ( n=24 ) diet and followed from 28 weeks gestation until delivery .  Self-monitored-blood-glucose ( SMBG ) , maternal and infant weight were collected from medical charts .  Dietary intakes were assessed using diet records and question naires . RESULTS diet GI on control ( 58 , 95 % CI : 56,60 ) was significantly higher than on low-GI ( 49 , 95 % CI : 47,51 ; p=0.001 ) . Glycaemic control improved on both diets , but more postpr and ial glucose values were within target on low-GI ( 58.4 % of n=1891 ) than control ( 48.7 % of n=1834 ; p<0.001 ) . SMBG post-breakfast was directly related to pre-pregnancy BMI in the control , but not the low-GI group ( BMI * diet interaction ; p=0.021 ) . Participants accepted the study foods and were willing to consume them post-intervention . CONCLUSIONS a low-GI diet was feasible and acceptable in this sample and facilitated control of postpr and ial glucose . A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes 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 vali date the guidelines , a clinical trial was design ed with clinic sites r and omly assigned to either nutrition practice guidelines care ( 12 sites ) or usual nutrition care ( 13 sites ) , with diabetes , obstetric , and other clinic types represented in both groups . Volunteer dietitians served as study coordinators and recruited women diagnosed with gestational diabetes mellitus . The nutrition practice guidelines define medical nutrition therapy ( MNT ) for gestational diabetes and emphasize three areas -definition of MNT clinical goals with indexes to modify or advance MNT and criteria to start insulin ; use of self-monitoring tools ; and provision of three nutrition visits . Usual care sites provided prenatal nutrition care according to usual practice . The effect of nutrition care ( sites following the nutrition care guidelines ) and type of clinic site on changes in glycated hemoglobin and infant birth weight , adjusted for other covariates , were evaluated using linear regression . Differences in insulin use and other infant outcomes between treatment groups were evaluated using logistic regression . Generalized estimating equations were used to accommo date nonindependence within r and omized clusters of patients within clinic sites . Data from 215 women indicated less  insulin use at diabetes clinic sites in the nutrition practice guidelines groups and improved glycated hemoglobin control during the treatment period in diabetes clinics compared with obstetric or other clinics . A higher proportion of women in the usual care group had glycated hemoglobin levels that exceeded 6 % at follow-up compared with women in the nutrition practice guidelines group ( 13.6 % vs 8.1 % ) , although not statistically significant ( P=0.26 ) . A significant clinic type and treatment group effect was found for birth weight . Nutrition practice guidelines for gestational diabetes mellitus reflected nutrition care already being provided by registered dietitians in diabetes clinics prior to this study because outcomes at these clinics were not impacted . Use of the guidelines by dietitians at obstetric and other clinics tended to improve outcomes at these sites Purpose To create a positive step toward achieving an efficient method for gestational diabetes treatment , the present study was carried out to compare the treatment outcomes based on single impaired blood glucose versus regular method in health care centers in Iran . Methods This r and omized clinical trial was carried out in Tehran/Iran between March 2012 and August 2013 . Study sample consisted of mothers whose fasting blood sugar was disturbed or a disturbed blood sugar was seen in OGTT with 75 g glucose load , according to ADA st and ards . For each outcome , multiple logistic regressions were used to control for the effects of potential confounders . When a confounder was measured on a continuous scale ( e.g. , age ) , LOWESS ( locally weighted scatter plot smoothing ) algorithm was used to determine whether the effect of that variable was linear . We also used the fractional polynomial regression to determine the optimal transformation of continuous covariates . Results The information of 189 pregnant women was used in this study ; 87 in the interventional group ( 46 % ) and 102 in the control group ( 54 % ) . Treatment based on the new protocol has very high protective effect ( OR 0.25 , 95 % CI 0.68–0.88 ) in terms of neonatal hyperbilirubinemia . This difference was not seen in other outcomes including stillbirth , macrosomic newborn delivery , hypoglycemia , and hypocalcemia . The risk of neonatal hypoglycemia reduced after the 25th week of gestation ( OR 0.39 , 95 % CI 0.15–0.98 ) . Conclusions Although the treatment of mild gestational diabetes could not significantly decrease severe neonatal outcomes , it did significantly reduce the risk of hyperbilirubinemia and its subsequent complications A r and omized multicenter study was conducted in the Stockholm‐Örebro areas in Sweden to evaluate how treatment aim ing at normoglycemia  affects fetal growth , pregnancy and neonatal outcome in pregnant women with severe hyperglycemia OBJECTIVE The purpose of this study was to evaluate the relationship between gestational age ( GA ) and induction of labor ( IOL ) and the rate of cesarean delivery in women with mild gestational diabetes mellitus . STUDY DESIGN We conducted a secondary analysis of data from a multicenter r and omized controlled trial of mild gestational diabetes mellitus treatment .  Cesarean delivery rate of women delivering at term ( ≥37 weeks ' gestation ) was evaluated by 2 complementary approaches : ( 1 ) IOL vs spontaneous labor : women who were induced at each GA compared with those who spontaneously labored at the same GA and ( 2 ) IOL vs expectant management : women who delivered after IOL at each GA compared with those who delivered after spontaneous labor at the same GA or subsequently after spontaneous or induced labor ( outcome at each week compared with expectant management at that week ) . Logistic regression adjusted for potential confounders . RESULTS The overall cesarean delivery rate was 13 % . When compared with 39 weeks ' gestation ( either IOL or spontaneous labor ) as the referent , there was no significant difference in the cesarean delivery rate in women who delivered at 37 , 38 , or 40 weeks ' gestation . However , IOL was associated with a 3-fold increase in cesarean delivery rate at 41 weeks ' gestation and beyond , as compared with IOL at 39 weeks ' gestation . Similarly , there was a 3-fold increase in the cesarean delivery rate in women who were induced when compared with those who were treated expectantly at 40 completed weeks ' gestation . CONCLUSION Induction of labor in women with mild gestational diabetes mellitus does not increase the rate of cesarean delivery at < 40 weeks ' gestation The purpose of this study was to examine pregnancy outcome in women with abnormal oral glucose tolerance tests , in relation to treatment with diet and insulin . Glucose tolerance tests , done because of well-known historical risk factors , were considered abnormal if two or more readings exceeded the following : fasting , 110 ; 1 hour , 170 ; 2 hours , 120 ; and 3 hours , 110 ( all in mg/100 mL , measured as total reducing substances in whole venous blood ) . Those with positive tests were divided r and omly into a “ positive-control ” group ( n 308 ) that received  st and ard prenatal care or a “ positive-treated ” group ( n 307 ) that received dietary instructions ( 30 kcal/kg ideal body weight , 40 % as carbohydrate , and 1.5–2 g protein/kg body weight ) and insulin ( initial dose 10 U per day of intermediate-acting insulin , adjusted subsequently as directed by blood and urine studies ) , beginning at usually about 32 weeks . A third group ( n 328 ) , termed “ negative controls , ” had exhibited normal glucose tolerance testing . The three groups were similar , except that those with abnormal glucose tolerance tended to be older and heavier , as expected . With respect to outcome , infants with birth weights exceeding 9 lb were three times as frequent in positive-control subjects as in either positive-treated subjects or negative controls ( 13.1 % , 4.3 % , and 3.7 % , respectively ) . Perinatal deaths ( 28 weeks ’ gestation through 14 days after birth ) were similar in the two positive groups ( 4.9 % in control and 4.3 % in treated ) and significantly higher than in negative controls ( 1.9 % ) , with the increase involving both fetal and neonatal components . The conclusions were 1 ) abnormal glucose tolerance during pregnancy leads to larger infants and higher perinatal mortality and 2 ) treatment with diet and insulin ameliorates the former but not the latter . This study concerned what O’Sullivan called potential diabetes and others at the time termed latent or chemical diabetes or prediabetes , but what today we refer to as gestational diabetes . Acceptance of it as a pathologic entity was far from unanimous in 1966 . O’Sullivan resolved the controversy with this large , well- design ed , and well-analyzed clinical trial . The immediate influence was two-fold . In the first place , it settled the existing disagreement as to whether or not impaired glucose tolerance adversely influences pregnancy outcome ; large infants occurred three times as frequently and perinatal deaths were more than doubled in women with abnormal carbohydrate metabolism . Second , the findings of the intervention trial indicated clearly that treatment of gestational diabetes with diet and insulin in late gestation normalizes birth weight ( although it did not seem to influence perinatal mortality ) , a finding confirmed a number of times by subsequent investigators . Incidentally , the frequencies of both fetal and neonatal deaths may seem high , but it needs to be remembered that this experience ante date d the advent of modern fetal surveillance and neonatal intensive care . John B. O’Sullivan , a pioneer in clinical research in gestational diabetes , was an internist . He defined st and ards for the oral glucose tolerance test in pregnancy that , though modified slightly by subsequent investigators , are basically those in use today . Born in 1926 , he received his medical education in his native Irel and before immigrating to the United States in 1955 . After further training in internal medicine at the Lahey Clinic , he took a faculty position at the Boston University School of Medicine , where he did his original work on early diabetes as medical director of the Prenatal Metabolism Clinic at Boston City Hospital and chief of medicine at St. Margaret ’s Hospital . In addition to his position as Associate Professor at Boston University , he also served on the faculties of the Harvard and Yale medical schools . Later he was director of employee health for the Liberty Mutual Insurance Company . He died of cancer in August 2001 CONTEXT Gestational diabetes mellitus ( GDM ) affects 3 % to 5 % of pregnancies . Knowledge of risk factors for GDM is needed to identify possible preventive strategies . OBJECTIVE To assess whether recognized determinants of noninsulin-dependent diabetes mellitus also may be markers for increased risk of GDM . DESIGN Prospect i ve cohort study . SETTING The Nurses ' Health Study II , which involves female US nurses aged 25 to 42 years at entry . PARTICIPANTS The analyses included 14613 women without previous GDM or other known diabetes who reported a singleton pregnancy between 1990 and 1994 . Of these women , 722 ( 4.9 % ) reported a new diagnosis of GDM . MAIN OUTCOME MEASURE Self-report of GDM , vali date d by medical record review in a subset . RESULTS In multivariate analyses including age , pregravid body mass index ( BMI ) , and other GDM risk factors , the risk for GDM increased significantly with increasing maternal age ( P for trend , < .01 ) and family history of diabetes mellitus ( relative risk , 1.68 ; 95 % confidence interval [ CI ] , 1.39 - 2.04 ) . Relative risks for GDM were 2.13 ( 95 % CI , 1.65 - 2.74 ) for pregravid BMI of 25 to 29.9 kg/m2 and 2.90 ( 95 % CI , 2.15 - 3.91 ) for BMI of 30 kg/m2 or more ( vs BMI of < 20 kg/m2 ) . Risk for GDM increased with greater weight gain in early adulthood , and it also increased among nonwhite women . Pregravid current smokers had a relative risk for GDM of 1.43 ( 95 % CI , 1.14 - 1.80 ) , and pregravid vigorous exercise was associated with a nonsignificant reduction in GDM risk . CONCLUSIONS Advanced maternal age , family history of diabetes mellitus , nonwhite ethnicity , higher BMI , weight gain in early adulthood , and cigarette smoking predict increased GDM risk . These observations may facilitate the identification of women at particular risk for GDM and suggest potential strategies for reducing this risk even before a woman becomes pregnant , such as avoiding substantial weight gain and smoking The outcome of pregnancy  in control and treated gestational diabetics was not significantly different . The decreased loss rate among the insulin- and diet-treated gestational diabetics , however , did become significant when the data were reanalyzed with consideration of two important influencing variables . The high-risk group of gestational diabetics aged 25 years and older who received  insulin therapy  before the 32nd week of gestation had fewer fetal losses . Documentation of the critical role played by both maternal age and the gestational age at which insulin therapy is commenced now makes the institution of a conclusive prospect i ve study feasible . The adequately established hypothesis that insulin management of gestational diabetics favorably affects the outcome of their pregnancies can then be finally resolved Infant macrosomia is a serious medical concern . Pregnant women who do not meet the specific diagnosis for gestational diabetes may still have glucose-mediated macrosomia . In Santa Barbara County all pregnant women are screened for gestational diabetes at 24 - 28 weeks with a 50-g , 1-hr glucose challenge test ( GCT ) . All patients who fail this test are placed on a st and ard euglycemic diet ( 40 % carbohydrate , 20 % protein , 40 % fat ) and perform home glucose monitoring of fasting and postpr and ial glucose levels . The objective of this study was to examine the effectiveness of this treatment program in decreasing infant macrosomia , maternal and infant morbidity , maternal complications , and operative delivery . We studied 103 women who had a positive GCT , but a negative 100-g , 3-hr oral glucose tolerance test ( OGTT ) . The women were r and omly assigned to either experimental or control groups with experimental women receiving dietary counseling and home glucose monitoring instruction ( HBGM ) . HBGM diaries were review ed weekly by clinic nurses . All women had hemoglobin A1c ( HbA1c ) tests at 28 and 32 weeks . Maternal and fetal charts were review ed to determine delivery type and complications , indications for cesarean section ( C-section ) , and infant gestational age , gender , Apgar scores , birth weight , morbidities , and congenital anomalies . Of the 103 women , 5 women required insulin treatment , 1 woman had an abortion , and 14 women were indeterminate regarding compliance or were control women who received diet counseling and HBGM . The results are based on 83 women--48 control and 35 experimental . There were no significant differences between the groups for age , parity , or weight at 28 - 30 weeks or 37 weeks to delivery , or HbA1c at 28 weeks . HbA1c was significantly higher in control women at 32 weeks . Birth weight expressed in grams or as a percentile specific for gender , ethnicity , and gestational age was significantly higher in control infants . Birth weight was significantly correlated with maternal intake weight , weight at 28 - 30 weeks , and weight at delivery and with HbA1c at 32 weeks ' gestation . There were no significant differences between groups for maternal complications . Groups were significantly different for mode of delivery with experimental women having more induced vaginal deliveries but fewer repeat C-sections than control women . Groups were not different for primary C-sections . Women who fail the GCT , but not the OGTT and thus do not receive the diagnosis of GDM are still at risk for delivering a macrosomic infant and operative delivery . Our program of treatment for all women who fail the GCT improves outcome by reducing infant birth weight and the number of cesarean sections This practice guideline on gestational diabetes is a treatment oriented short version of the evidence based guideline that can be viewed in the internet . It replaces the DDG and DGGG recommendations of 2001 for diagnostic and therapy of gestational diabetes . A complete rework had become necessary in view of epidemiologically based diagnostic criteria , which had been derived from the Hyperglycaemia and Adverse Pregnancy Outcome study ( HAPO ) by international consensus , and in view of r and omised therapy and observation studies published after 2001 . With this , Germany has adopted the international st and ard . Screening and diagnosing gestational diabetes by means of blood glucose are part of the legally binding maternity guidelines in Germany since March 3 , 2012 Background : There are no r and omised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus ( GDM ) diagnosed by the International Association of Diabetes and Pregnancy Study Group ’s ( IADPSG ) criteria . We tested the effectiveness of lifestyle modifications implemented in a 3-tier ’s shared care ( SC ) on pregnancy outcomes of GDM . Methods : Between December 2010 and October 2012 , we r and omly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 ( interquartile range : 25.4 - 27.3 ) gestational weeks in Tianjin , China , to receive SC or usual care ( UC ) . The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group . The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension ( PIH ) . Results : Women in the SC ( n = 339 ) and UC ( n = 361 ) groups delivered their infants at similar gestational weeks . Birth weight of infants in the SC group was lower than that in the UC group ( 3469 vs. 3371 grams , P = 0.021 ) . The rate of macrosomia was 11.2 % ( 38/339 ) in the SC group compared to 17.5 % ( 63/361 ) in the UC group with relative risk ( RR ) of 0.64 ( 95 % CI : 0.44 - 0.93 ) . The rate of PIH was 8.0 % ( 27/339 ) in the SC compared to 4.4 % ( 16/361 ) in the UC with RR of 1.80 ( 0.99 - 3.28 ) . Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC OBJECTIVE : To estimate the association between fasting and 2-hour postpr and ial blood glucose levels and neonatal outcomes  in women treated for mild gestational diabetes . METHODS : In this secondary analysis of a multicenter r and omized treatment trial of mild gestational diabetes , the median fasting and 2-hour postpr and ial 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 postpr and ial 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 ) , postpr and ial breakfast ( P<.001 ) , and postpr and ial lunch ( P<.001 ) glucose values declined over the treatment period , whereas postpr and ial 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 : AIM This r and omized controlled trial was carried out to investigate the effect of mindfulness eating and yoga exercise on blood sugar levels among pregnant Thai women with GDM . BACKGROUND Interventions promoting achievement of good glycemic control result in desired pregnancy outcomes . Little is known about the health benefits of mindfulness eating and yoga exercise on blood sugar levels among pregnant with GDM . METHODS A r and omized controlled trial was carried out . Main outcome measures were capillary fasting plasma glucose , 2-h postpr and ial blood glucose , and hemoglobin A1c . RESULTS The intervention group showed significantly reduced fasting plasma glucose , 2-h postpr and ial blood glucose , and glycosylated hemoglobin ( HbA1c ) in the intervention group ( p<0.05 ) . CONCLUSIONS Mindfulness eating and yoga exercise had health benefits on glycemic control in pregnant women with GDM . It should be recommended in clinical and community health services OBJECTIVE To examine the effects of a Parish Nurse Intervention Program ( PNIP ) on maternal health behaviors , glycemic control , and neonatal outcomes among Mexican American women with gestational diabetes . DESIGN A r and omized controlled trial comparing care as usual ( CAU ) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse . SETTING An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care , non-profit hospital with a Parish Nurse partnership . PARTICIPANTS One hundred Mexican American women were included in the study with r and omization into Parish Nurse Intervention Program ( n=49 ) and care as usual ( n=51 ) groups . MAIN OUTCOME MEASURES The Health Promoting Lifestyle Profile II ( HPLP II ) and two measures of glycemic control pre- and post-intervention , as well as newborn size , and days of maternal and neonatal hospitalization . RESULTS Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group . No significant differences between groups regarding glycemic control , macrosomia , or days of maternal or neonatal hospitalization were found . CONCLUSIONS A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors OBJECTIVE The purpose of this study was to examine the association between gestational age ( GA ) at the time of treatment initiation for gestational diabetes mellitus ( GDM ) and maternal and perinatal outcomes . STUDY DESIGN We conducted a secondary analysis of a multicenter r and omized treatment trial of mild GDM in which women with mild GDM were assigned r and omly to treatment vs usual care . The primary outcome of the original trial , as well as this analysis , was a composite perinatal adverse outcome that included neonatal hypoglycemia , hyperbilirubinemia , hyperinsulinemia , and perinatal death . Other outcomes that were examined included the frequency of large for GA , birthweight , neonatal intensive care unit admission , gestational hypertension/preeclampsia , and cesarean delivery . The interaction between GA at treatment initiation ( stratified as 24 - 26 , 27 , 28 , 29 , and ≥30 weeks of gestation ) and treatment group ( treated vs routine care ) , with the outcomes of interest , was used to determine whether GA at treatment initiation was associated with outcome differences . RESULTS Of 958 women whose cases were analyzed , those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared with those who initiated treatment at a later GA ( probability value for interaction with the primary outcome , .44 ) . Similarly , there was no evidence that other outcomes were improved significantly by earlier initiation of GDM treatment ( large for GA , P = .76 ; neonatal intensive care unit admission , P = .8 ; cesarean delivery , P = .82 ) . The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia ( P = .04 ) , although there was not a clear cut GA trend where this outcome improved with treatment . CONCLUSION Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes Objective : A planned study is described which will determine whether a benefit exists for the treatment of mild carbohydrate intolerance during pregnancy . Methods : A r and omized clinical trial of women with mild gestational diabetes will compare perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . Results : The primary outcome of this study will be a composite of neonatal morbidity in the treatment and control groups . Conclusions : A r and omized treatment trial of mild gestational diabetes mellitus will clarify whether identification and treatment of mild gestational diabetes mellitus reduces perinatal morbidity . This information will aid in selecting appropriate thresholds for the treatment of gestational diabetes mellitus OBJECTIVE The aim of the article is to determine whether maternal body mass index ( BMI ) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus ( GDM ) . STUDY DESIGN Secondary analysis of a multicenter r and omized treatment trial of women with GDM . Outcomes of interest were elevated umbilical cord c-peptide levels ( > 90th percentile 1.77 ng/mL ) , large for gestational age ( LGA ) birth weight ( > 90th percentile ) , and neonatal fat mass ( g ) . Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal , overweight , and obese adults . Outcomes were analyzed according to treatment group assignment . RESULTS A total of 958 women were enrolled ( 485 treated and 473 controls ) .  Maternal BMI at enrollment was not related to umbilical cord c-peptide levels . However , treatment of women in the overweight , Class I , and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass . Neither measure of excess fetal growth was reduced with treatment in normal weight ( BMI < 25 kg/m(2 ) ) or Class III ( BMI ≥ 40 kg/m(2 ) ) obese women . CONCLUSION There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese . These effects were not apparent for normal weight and very obese women OBJECTIVE The main purpose of this article is to evaluate whether identification and treatment of women with mild gestational diabetes mellitus ( GDM ) during pregnancy affects subsequent maternal body mass index ( BMI ) , anthropometry , metabolic syndrome , and risk of diabetes . STUDY DESIGN This is a follow-up study of women who participated in a r and omized controlled treatment trial for mild GDM . Women were enrolled between 5 and 10 years after their index pregnancy . Participants underwent  blood pressure , height , weight , and anthropometric measurements by trained nursing personnel using a st and ardized approach . A nurse-assisted question naire regarding screening and treatment of diabetes or hypercholesterolemia , diet , and physical activity was completed . Laboratory evaluation included fasting serum glucose , fasting insulin , oral glucose tolerance test , and a lipid panel . Subsequent diabetes , metabolic syndrome , obesity , and adiposity in those diagnosed with mild GDM and r and omized to nutritional counseling and medical therapy ( treated ) were compared with those who underwent routine pregnancy management ( untreated ) . Multivariable analyses were performed adjusting for race/ethnicity and years between r and omization and follow-up visit . RESULTS Four-hundred fifty-seven women with mild GDM during the index pregnancy were included in this analysis ( 243 treated ; 214 untreated ) and evaluated at a median 7 years after their index pregnancy . Baseline and follow-up characteristics were similar between treatment groups . Frequency of diabetes ( 9.2 vs. 8.5 % , p = 0.80 ) , metabolic syndrome ( 32.2 vs. 34.3 % , p = 0.63 ) , as well as adjusted mean values of homeostasis model assessment for insulin resistance ( 2.5 vs. 2.3 , p = 0.11 ) and BMI ( 29.4 vs. 29.1 kg/m2 , p = 0.67 ) were also not different . CONCLUSION Identification and treatment of women with mild GDM during pregnancy had no discernible impact on subsequent diabetes , metabolic syndrome , or obesity 7 years after delivery The benefits of exercise and behavioural recommendations in gestational diabetes mellitus ( GDM ) are controversial . In a r and omized trial with a 2 × 2 factorial design , we examined the effect of exercise and behavioural recommendations on metabolic variables , and maternal/neonatal outcomes in 200 GDM patients . All women were given the same diet : group D received dietary recommendations only ; group E was advised to briskly walk 20‐min/day ; group B received behavioural dietary recommendations ; group BE was prescribed the same as B + E.  Dietary habits improved in all groups . In a multivariable regression model , fasting glucose did not change . Exercise , but not behavioural recommendations , was associated with the reduction of postpr and ial glucose ( p < 0001 ) , glycated haemoglobin ( HbA1c ; p < 0.001 ) , triglycerides ( p = 0.02 ) and C‐reactive protein ( CRP ; p < 0.001 ) and reduced any maternal/neonatal complications ( OR = 0.50 ; 95%CI=0.28–0.89;p = 0.02 ) . In GDM patients  a simple exercise programme reduced maternal postpr and ial glucose , HbA1c , CRP , triglycerides and any maternal/neonatal complications , but not fasting glucose values 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 r and omly 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 r and omly 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 . ( Clinical Trials.gov number , NCT00069576 . OBJECTIVE This study identified the impact of intensive therapy on neonatal outcomes in women with gestational diabetes mellitus ( GDM ) and determined the effects on the postpartum metabolic status of the mothers . RESEARCH DESIGN AND METHODS In total , 127 pregnant women with GDM were r and omly selected to receive an intensive treatment regimen , which included one-to-one education , lifestyle intervention , scheduled clinic visits , strict glucose control , and frequent glucose self-monitoring . Meanwhile , 148 age-matched pregnant women with GDM were selected as controls and given the st and ard treatment regimen .  Pregnancy outcomes including parameters related to the GDM mothers and to their neonates were comparatively analyzed between the two treatment groups . GDM patient follow-up ( range , 1 - 3 years after delivery ) included an oral glucose tolerance test and measurements of lipid concentration and insulin secretion . The insulinogenic index ( ΔInsulin(30 min)/ΔBlood glucose(30 min ) ) and homeostasis model assessment index of β-cell function and insulin resistance were calculated . The patients ' demographic and anthropometric data were also recorded for comparative analysis . RESULTS Compared with GDM patients receiving st and ard treatment , GDM patients receiving intensive treatment had lower instances of premature delivery ( 2.4 % vs. 8.3 % , P<0.05 ) and neonatal care unit admission ( 21.3 % vs. 33.3 % , P<0.05 ) and lower neonatal birth weight ( 3.26±0.53 vs. 3.45±0.55 kg , P<0.0001 ) . At follow-up , GDM patients from the intensive treatment group had a smaller waist circumference ( 75.83±3.11 vs. 78.34±4.20 cm , P<0.01 ) , lower 30-min glucose levels after a 75-g glucose load ( 8.26±1.85 vs. 9.46±2.74 mmol/L , P<0.05 ) , and higher high-density lipoprotein levels ( 1.30±0.24 vs. 1.18±0.23 mmol/L , P<0.05 ) . CONCLUSIONS The intensive GDM treatment regimen led to healthier outcomes for the women , the neonates , and the birth event and was associated with better maternal metabolic situations in the months and years after delivery Objective . To examine pregnancy outcomes in relation to different categories of glucose tolerance during pregnancy . Design . Prospect i ve observational cohort study . Setting . Patient recruitment and data collection were performed in four delivery departments in southern Sweden . Population . Women delivering during 2003–2005 ; 306 with gestational diabetes mellitus , 744 with gestational impaired glucose tolerance and 329 r and omly selected controls . Methods . All women were offered a 75 g oral glucose tolerance test during pregnancy . On the basis of their capillary 2‐hour plasma glucose concentrations , three groups were identified : gestational diabetes mellitus ( > 10.0 mmol/l ) , gestational impaired glucose tolerance ( 8.6–9.9 mmol/l ) and controls ( < 8.6 mmol/l ) . Data for the groups were compared using a population ‐based data base . Main outcome measures . Maternal and fetal outcomes . Results . For the gestational diabetes mellitus group , adjusted odds ratios ( 95 % confidence intervals ) for hypertensive disorders during pregnancy and induction of labor and emergency cesarean section were 2.7 ( 1.3–5.8 ) , 3.1 ( 1.8–5.2 ) and 2.5 ( 1.5–4.4 ) , respectively ; and for Apgar score < 7 at 5 minutes , need for neonatal intensive care > 1 day and large‐for‐gestational age infant were 9.6 ( 1.2–78.0 ) , 5.2 ( 2.8–9.6 ) and 2.5 ( 1.3–5.1 ) , respectively . The increases in odds ratios for the gestational impaired glucose tolerance group were less pronounced but still significant for hypertension during pregnancy , induction of labor , large‐for‐gestational age infant and use of neonatal intensive care > 1 day , with odds ratios ( 95 % confidence interval ) 2.0 ( 1.0–4.1 ) , 1.8 ( 1.1–3.0 ) , 2.1 ( 1.1–3.9 ) and 2.1 ( 1.1–3.8 ) , respectively . Conclusions . These data indicate that even limited degrees of maternal hyperglycemia may affect the outcome of pregnancy
BACKGROUND Gestational diabetes ( GDM ) is glucose intolerance , first recognised in pregnancy and usually resolving after birth .
GDM is associated with both short- and long-term adverse effects for the mother and her infant .
Lifestyle interventions are the primary therapeutic strategy for many women with GDM .
OBJECTIVES To evaluate the effects of combined lifestyle interventions with or without pharmacotherapy in treating women with gestational diabetes .