The Toronto Tri-Hospital Gestational Diabetes Project. A preliminary review. Physical activity and gestational diabetes mellitus among Hispanic women. Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Borderline gestational diabetes mellitus and pregnancy outcomes Metformin compared with glyburide for the management of gestational diabetes. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Impaired Glucose Tolerance in Adolescent Offspring of Diabetic Mothers: Relationship to fetal hyperinsulinism Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Growth Patterns of Large-for-Gestational-Age and Appropriate-for-Gestational-Age Infants of Gestational Diabetic Mothers and Control Mothers at Age 1 Year [Treating women with gestational impaired glucose tolerance reduces adverse outcome of pregnancy]. A prospective study of pregravid determinants of gestational diabetes mellitus. Treatment of women with an abnormal glucose challenge test (but a normal oral glucose tolerance test) decreases the prevalence of macrosomia. Infant overweight is associated with delayed motor development. A multicenter, randomized trial of treatment for mild gestational diabetes. The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut‐off criteria for abnormal glucose tolerance
In this study , we assessed maternal-fetal outcomes in untreated patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes mellitus ( GDM ) , examined the relationship between birth weight and mode of delivery among women with untreated borderline GDM , treated overt GDM , and normoglycemia , and established more efficient screening strategies for detection of GDM . This was a prospect i ve analytic cohort study in which nondiabetic women aged > or = 24 years were eligible for enrollment . A 50-g glucose challenge test ( GCT ) and a 100-g oral glucose tolerance test ( OGTT ) were administered at 26 and 28 weeks gestational age , respectively . Risk factors for unfavorable maternal-fetal outcomes were recorded . Time since the last meal  prior to the screening test was recorded , as well . Caregivers and patients were blinded to glucose values except when test results met the National Diabetes Data Group criteria for GDM . Maternal and fetal outcomes , including the mode of the delivery , were recorded in the postpartum period . Of 4,274 patients screened , 3,836 ( 90 % ) continued to the diagnostic oral glucose tolerance test . GDM was seen in 145 women . Increasing carbohydrate intolerance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean section , preeclampsia , macrosomia , and need for phototherapy , as well as an increased length of maternal and neonatal hospital stay . Multivariate analysis showed that increasing carbohydrate intolerance remained an independent predictor for various unfavorable outcomes , but the strength of the associations was diminished . Compared with normoglycemic control subjects , the untreated borderline GDM group had increased rates of macrosomia ( 28.7 vs. 13.7 % , P < 0.001 ) and cesarean delivery ( 29.6 vs. 20.2 % , P = 0.03 ) . Usual care of known GDM patients normalized birth weights , but the cesarean delivery rate was about 33 % , whether macrosomia was present or absent . An increased risk of cesarean delivery among treated patients compared with normoglycemic control subjects persisted after adjustment for multiple maternal risk factors . As for the screening tests , time since the last meal had a marked effect on mean plasma glucose . Receiver operating characteristic curve analysis allowed the selection of the most efficient cut points for the GCT based on the time since the last meal . These cut points were 8.2 , 7.9 , and 8.3 mmol/l ( 1 mmol/l = 18.015 mg/dl ) for elapsed postpr and ial time of < 2 , 2 - 3 , and > 3 h , respectively . With this change from the current threshold of 7.8 mmol/l , the number of patients with a positive screening test dropped from 18.5 to 13.7 % . There was an increase in positive predictive value from 14.4 to 18.7 % . The overall rate of patient misclassification fell from 18.0 to 13.1 % . In conclusion , increasing maternal carbohydrate intolerance in pregnant women without GDM is associated with a grade d increase in adverse maternal and fetal outcomes . Infant macrosomia is an important factor in high cesarean delivery rates for women with untreated borderline GDM . Although detection and treatment of GDM normalizes birth weights , rates of cesarean delivery remain inexplicably high . Recognition of GDM may lead to a lower threshold for surgical delivery . The efficiency of screening for GDM can be enhanced by adjusting the current GCT threshold of 7.8 mmol/l to new values related to time since the last meal before screening . Further analyses are underway to eluci date whether maternal risk factors can be used to achieve additional efficiency gains in screening 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 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 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 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 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 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 To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero . RESEARCH DESIGN AND METHODS We enrolled offspring of women with pregestational diabetes ( this included insulin-dependent diabetes mellitus . [ 1DDM ] and non-insulin-dependent diabetes mellitus [ NIDDM ] ) and gestational diabetes in a prospect i ve study from 1977 through 1983 . Fetal /3-cell function was assessed by measurement of arrmiotic fluid insulin ( AF1 ) at 32–38 weeks gestation . Postnatally , plasma glucose and insulin  were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose . Control subjects had a single oral glucose challenge at 10 - 16 years . RESULTS In offspring of diabetic mothers , the prevalence of impaired glucose tolerance ( IGT ) ( 2-h glucose concentration > 7.8 mmol/1 ) was : 1.2 % at < 5 years , 5.4 % at 5–9 years , and 19.3 % at 10–16 years . The 88 offspring of diabetic mothers ( 12.3 ± 1.7 years ) , when compared with 80 control subjects of the same age and pubertal stage , had higher 2-h glucose ( 6.8 ±1.4 vs. 5.7 ± 0.9 mmol/1 , P < 0.001 ) and insulin ( 660 ± 720 vs. 455 ± 285 pmol/1 , P < 0.03 ) concentrations . The 17 subjects with IGT at > 10 years of age ( 9 boys and 8 girls ) include one girl with NIDDM . IGT was not associated with the etiology of the mother 's diabetes ( gestational versus pregestational ) or macrosomia at birth . IGT was found in only 3.7 % ( 1 of 27 ) of adolescents whose AFI was normal ( ≥100 pmol/l ) and 33.3 % ( 12 of 36 ) of those with elevated AFI ( P < 0.001 ) . Although most of the children with IGT are obese , AFI and obesity are independently associated with IGT by multiple logistic analysis . CONCLUSIONS In confirmation of our original hypothesis , IGT in the offspring is a long-term complication of maternal diabetes . Excessive insulin secretion in utero , as assessed by AFI concentration , is a strong predictor of IGT in childhood OBJECTIVE The purpose of this study was to assess the long-term effects of maternal prenatal factors , including gestational diabetes mellitus ( GDM ) , adiposity , and weight gain during pregnancy , on adiposity of offspring from 4 to 7 years of age . A second purpose was to investigate the relationships among childhood adiposity , blood pressure , and 2-h postpr and ial glucose level . RESEARCH DESIGN AND METHODS Prospect i ve observational study of four groups of children including large-for-gestational-age ( LGA ) offspring of mothers with gestational diabetes ( OGDM ) ; appropriate-for-gestational-age ( AGA ) OGDM ; LGA control subjects ; and AGA control subjects .  Anthropometrics including skin-fold measurements , blood pressure measurements , and a 2-h postpr and ial glucose measurement  were obtained at each visit . Repeated measures analysis of variance models were used to detect different patterns of longitudinal change among the groups . RESULTS LGA OGDM were more likely to be heavier , have larger circumferences and skin-fold measurements , and have a higher BMI than AGA OGDM and control subjects , and these findings increased with increasing age . Blood pressures and postpr and ial glucose values were similar for OGDM and control subjects at 4 - 7 years . Multivariable analyses showed that infant BMI and maternal prepregnant BMI predicted 7-year BMI for OGDM , whereas for control subjects , maternal prepregnancy BMI and weight gain during pregnancy were positive predictors with a small negative contribution from birth BMI . CONCLUSIONS We conclude that LGA OGDM have evidence of increasing body size and adiposity with increasing age and that maternal GDM and maternal prepregnant adiposity are significant predictors of their unique growth patterns 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 OBJECTIVE The purpose of this study was to explore the development of adiposity in macrosomic and normosomic infants of mothers with gestational diabetes mellitus ( GDM ) and control subjects between birth and age 1 year , and assess its relation to maternal prenatal factors and neonatal factors . RESEARCH DESIGN AND METHODS This was a prospect i ve observational study of 192 infants , including 47 large-for-gestational-age ( LGA ) infants of GDM mothers , 47 appropriate-for-gestational-age ( AGA ) infants of GDM mothers , 55 LGA control infants , and 44 AGA control infants who were evaluated at birth and age 1 year . Maternal prenatal and pregnancy anthropometric measurements were recorded . Multiple infant anthropometric measurements , including skinfold thicknesses , were obtained at birth and age 1 year . Regression models were run to detect the independent effects of various maternal and infant factors on 1-year child adiposity , adjusting for their effects at birth . RESULTS LGA infants of GDM mothers had a higher BMI , waist circumference , and abdominal skinfold at age 1 year compared with all other study groups . Among infants of GDM mothers , the mean 2-h postpr and ial glucose value for the second and third trimester correlated with waist circumference ( r = 0.28 , P < 0.04 ) and subscapular skinfold ( r = 0.37 , P < 0.007 ) , and correlated marginally with 1-year sum of four skinfolds . Among infants of GDM mothers , a regression of 1-year sum of four skinfolds was significantly related to maternal prepregnancy weight after controlling for sum of skinfolds at birth . For control infants , the maternal glucose screen value was significantly associated with 1-year sum of skinfolds adjusted for the birth sum of skinfolds . CONCLUSIONS We concluded that macrosomic infants of GDM mothers have unique patterns of adiposity that are present at birth and persist at age 1 year . Further , we concluded that maternal factors , including adiposity and intrauterine fuel environment , influence the presence and distribution of adiposity for both infants of GDM mothers and control infants OBJECTIVE To study the treatment of women with gestational impared glucose tolerance ( GIGT ) in relation to outcome of fetus and newborns . METHODS 98 women with GIGT were r and omized into untreated ( 37 mothers ) and treated groups ( 61 mothers ) that included diet control and insulin therapy . The perinatal outcomes were compared in the two groups . RESULTS The incidence of macrosomia ( P < 0.01 ) and fetal distress ( P < 0.05 ) was found to be significantly higher in the untreated group when compared with the treated group . The prevalence of neonatal metabolic complications in the untreated group was higher than that of the treated group as well . CONCLUSION Treatment of women with GIGT will reduce adverse outcome in pregnancy 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 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 OBJECTIVE To examine how infant overweight and high subcutaneous fat relate to infant motor development . STUDY DESIGN Participants were from the Infant Care , Feeding , and Risk of Obesity Project , a prospect i ve , longitudinal study of low-income African-American mother-infant dyads assessed from 3 to 18 months of age ( 836 observations on 217 infants ) . Exposures were  overweight ( weight-for-length z-score > or=90th percentile of 2000 Centers for Disease Control/National Center for Health Statistics growth reference ) and high subcutaneous fat ( sum of 3 skinfold measurements > 90th percentile of our sample ) . Motor development was assessed by using the Bayley Scales of Infant Development-II . Developmental delay was characterized as a st and ardized Psychomotor Development Index score<85 . Longitudinal models estimated developmental outcomes as functions of time-varying overweight and subcutaneous fat , controlling for age and sex . Alternate models tested concurrent and lagged relationships ( earlier weight or subcutaneous fat predicting current motor development ) . RESULTS Motor delay was 1.80 times as likely in overweight infants compared with non-overweight infants ( 95 % CI,1.09 - 2.97 ) and 2.32 times as likely in infants with high subcutaneous fat compared with infants with lower subcutaneous fat ( 95 % CI , 1.26 - 4.29 ) . High subcutaneous fat was also associated with delay in subsequent motor development ( odds ratio , 2.27 ; 95 % CI , 1.08 - 4.76 ) . CONCLUSIONS Pediatric overweight and high subcutaneous fat are associated with delayed infant motor development 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 . 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 Pregnancy hyperglycaemia without meeting gestational diabetes mellitus ( GDM ) diagnostic criteria affects a significant proportion of pregnant women each year .
It is associated with a range of adverse pregnancy outcomes .
Although intensive management for women with GDM has been proven beneficial for women and their babies , there is little known about the effects of treating women with hyperglycaemia who do not meet diagnostic criteria for GDM and type 2 diabetes ( T2DM ) .
OBJECTIVES To assess the effects of different types of management strategies for pregnant women with hyperglycaemia not meeting diagnostic criteria for GDM and T2DM ( referred as borderline GDM in this review ) .