In twin pregnancies, weight gain below recommended guidelines determined by maternal PPBMI is associated with higher rates of spontaneous preterm delivery at <35 weeks.
OBJECTIVE -Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17␣-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth.RESEARCH DESIGN AND METHODS -Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy. Included were patients enrolled for outpatient management at Ͻ27 weeks' gestation with documented pregnancy outcome and delivery at Ͼ28 weeks. Patients with preexisting diabetes were excluded. The incidence of GDM was compared between patients who received prophylactic intramuscular 17P (250-mg weekly injection initiated between 16.0 and 20.9 weeks' gestation) and those who did not.RESULTS -Maternal BMI and age were similar. The incidence of GDM was 12.9% in the 17P group (n ϭ 557) compared with 4.9% in control subjects (n ϭ 1,524, P Ͻ 0.001; odds ratio 2.9 [95% CI 2.1-4.1]).CONCLUSIONS -The use of 17P for the prevention of recurrent preterm delivery is associated with an increased risk of developing GDM. Early GDM screening is appropriate for women receiving 17P prophylaxis.
Diabetes Care 30:2277-2280, 2007P reterm birth is the leading cause of perinatal mortality and morbidity for nonanomalous infants in the U.S. where Ͼ12% of infants, ϳ480,000, are born prematurely each year (1). Although past studies of progestational agents for the prevention of preterm delivery reported varied results, there has been renewed interest in the use of 17␣-hydroxyprogesterone caproate (17P) as a secondary preterm birth prevention strategy after a recent study from the National Institute of Child Health and Human 3). This study examined the effectiveness of 17P in reducing the rate of preterm delivery in women with a singleton gestation and a history of prior preterm delivery. 17P was administered via weekly injections initiated between 16 and 20 weeks' gestation and was shown to decrease the incidence of recurrent preterm birth in the study population by 33% (3). Meta-analysis including both older and current studies has provided further support for the use of 17P for preterm birth prevention (4), although the mechanism of action by which 17P prevents preterm birth remains poorly understood.The metabolic changes of normal pregnancy are essential to provide adequate nutrients to the growing fetus. As pregnancy progresses, increased levels of human chorionic sommatomammotropin, cortisol, prolactin, progesterone, and estrogen lead to insulin resistance. Studies in animal models demonstrate that progesterone plays an important role in signaling insulin release and pancreatic function (5). The relatively diabetogenic properties of progesterone, which peak at 32 weeks' gestation, have been described in humans (6). The American Diabetes Association (ADA) recommends screening all women at risk for gestational dia...
Background:The Olympic and Paralympic Games rely heavily on volunteers to provide many essential services, including medical care of athletes.Objective:This preliminary investigation sought to characterise the motivational influences and factors responsible for the satisfaction of Olympic and Paralympic healthcare volunteers.Methods:The 2002 Winter Games polyclinic healthcare volunteers were asked to complete a questionnaire designed to elicit information about their motives for volunteering and the factors that contributed to their satisfaction with their volunteer experience.Results:There was no significant difference in the motivation or satisfaction summary scores based on event worked. There was a strong positive correlation between motivation and satisfaction. Physician respondents had a lower mean motivation score than did non-physician volunteers.Conclusions:There were no significant motivational differences between Olympic and Paralympic volunteers, but there were several differences noted between physician and non-physician volunteers. The 2002 polyclinic volunteers appear to have been motivated by a complex process best described as “enlightened self interest,” and all were generally well satisfied with their experience. These results may assist organisers of future Games in selecting appropriately motivated volunteer personnel and creating rewarding work environments for them.
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