Summary. Random plasma glucose was determined in 276 apparently healthy pregnant women attending our antenatal clinic at 28 to 32 weeks gestation. Mean and standard deviation values within 2 h and >2 h after a meal were calculated. A standard 75‐g oral glucose tolerance test was then given to 250 of the 276 pregnant women. Three patients were found to be diabetic and 46 had post‐load concentrations indicative of impaired glucose tolerance according to the criteria of the World Health Organization (1980). Using a cut‐off point whereby 15% of the population would be tested, we would have identified only 2 of the 3 diabetics and 12 of the 46 with impaired glucose tolerance. This poor predictive power cannot be resolved by altering cut‐off points for screening, or by altering the criteria for abnormal glucose tolerance. The basic problem is lack of a close relation between 2‐h glucose tolerance value and random glucose when this has been taken >120 min after a meal. In this population with a high prevalence of abnormal glucose tolerance, random plasma glucose is not an efficient screening test.
Ubjective--?o study the prevalence and type of glucose intolerance in pregnancy and the effect of different types on pcrinatal mortality and fetal size. Design-A prospective case-control study with data collected by patient intcrview and cxarnination of all available records during a 16-months period between 1984 and 1086. Serriiig-A large maternity hospital in Kuwait where diabetes in pregnancy is common.Suhjrcrs-Thc cases wcrc a consccutivc sample of 731 wonieii, delivered during thc study pcriod, recorded in the labour ward regi5ter as hcing diabetic or having abnormal glucose tolerance, the control group was formed from the next woinan in the register (provided she was not known to be diabetic). i2.luiw orircuine /neusures-Type of diabetes followed the WHO classification, with subdivision depending on level of faqting plawia glucosc. ' r p c of perinatal death was examined in detail and birthweight ccntilc calculated. Results-Of the 731 eases, 22Y0 werc established diabetics, most werc treated with oral hypoglycacniic drugs before pregnancy and insulin duriiig pi-egnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Establishcd diabetics had il pcrinatal mortality rate nearly four tirncs grcatcr than non diahctics (KK, 37.95% Cl2.6to6.4) aridf(irgestationa1diabeiics RRwas2.095"/6 ( 3 1 . 2 to3.7). Uncxplaiiied deaths were pal-ticularly common, both in established diabetics (RR, 28.4. 95% CI 3.9 to 85.7) and in gestational diabetics (KR, 134. 95% (C'1 2.9 to 61.6). Cases with impaired glucose tolerance had n o stillbirths and had a lower perinatal 10s.; than the controls. though this was not statistically significant. Heavier babies were scen in all case groups compared with controls, though the impaired glncosc tolcrancc group had lower birthweights than the other two case groups. Cwzdzuions-l y p e 2 diabetes was found to bc common, most cases bcing diagnoscd in pregnancy. Under the conditions found in Kuwait. diabetes, in the sense of a raised fasting glucose. is acconipanicd by a high rate of pcriiiatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fctal inacrosoinia was also common i n both situations. Inipaii cd glucose tolerance, where fasting levels remain normal. does not appear to increase fetal loss, but may be associated with fetal macrosoniia. As these women age they arc likely to develop overt diabetes in the non-pregnant state, and suhxqucntly to dcvclop serious complications of this disease. Improving glycacniic control, both during pregnancy and subsequently. should be a priority.Establiahed diabetes is generally recognized as a cause of increased perinatal mortality; in one of the few total population studies. fetal death was nine times more common than in births to non diabetics (Connell rt ul. 1085). 'There is? how-cvcr, argument about the clinical significance of abnorin...
IGT, as defined by the World Health Organization, did not result in any adverse outcomes.
Prostaglandin E2 vaginal pessaries proved to be a safe and effective method for induction of labor in grandmultiparous women.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.