Aims/IntroductionThe International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes are associated with increased prevalence. However, it remains unknown if intervention for more women with gestational diabetes mellitus by the IADPSG criteria results in better pregnancy outcomes than adopting the Carpenter and Coustan (C&C) criteria in Asian populations.Materials and MethodsThis was a retrospective cohort study. A total of 1,840 women, 952 subjects by the IADPSG criteria and 888 subjects by the C&C criteria, who delivered singletons in 2011 in a single tertiary center, were included in the study. The same therapeutic interventions were offered to women with gestational diabetes mellitus by the two criteria. Maternal and neonatal outcomes were evaluated.ResultsAdopting the IADPSG criteria increased the prevalence of gestational diabetes mellitus diagnosis to 13.44%, compared with 2.59% by the C&C criteria. The diagnosis was made 3 weeks earlier by the IADPSG criteria (27 vs 30.5 weeks, P < 0.0001). Adopting the IADPSG criteria was associated with reduced risk of primary cesarean section (adjusted odds ratio 0.79, 95% confidence interval 0.63–0.998, P < 0.05) and having any one of the adverse fetal outcomes (adjusted odds ratio 0.79, 95% confidence interval 0.64–0.998, P < 0.05), including birthweight >90th percentile, jaundice, admission to neonatal intensive care unit, birth trauma, neonatal hypoglycemia and fetal death.ConclusionsAdopting the IADPSG criteria is associated with improved pregnancy outcomes, at the expense of increased prevalence of gestational diabetes mellitus diagnosis.

ObjectiveUsing a specific cutoff of fasting plasma glucose (FPG) to screen gestational diabetes mellitus (GDM) can reduce the use of oral glucose tolerance tests (OGTT). Since the prevalence of GDM increases with age, this screening method may not be appropriate in healthcare systems where women become pregnant at older ages. Therefore, we aimed to develop a screening algorithm for GDM that takes maternal age into consideration.MethodsWe included 945 pregnant women without history of GDM who received 75g OGTT to diagnose GDM in 2011. Screening algorithms using FPG with or without age were developed. Another 362 pregnant women were recruited in 2013–2015 as the validation cohort.ResultsUsing FPG criteria alone, more GDM diagnoses were missed in women ≥35 years than in women <35 years (13.2% vs. 5.8%, p <0.001). Among GDM women ≥35 years, 63.6% had FPG <92 mg/dL (5.1 mmol/L). Use of the algorithm with an “age plus FPG” cutoff could reduce the use of OGTT (OGTT%) from 77.6% to 62.9%, while maintaining good sensitivity (from 91.9% to 90.2%) and specificity (from 100% to 100%). Similar reduction in OGTT% was found in the validation cohort (from 86.4% to 76.8%). In the simulation, if the percentage of women ≥35 years were 40% or more, the screening algorithm with an “age plus FPG” cutoff could further reduce OGTT% by 11.0%-18.8%.ConclusionsA screening algorithm for GDM that takes maternal age into consideration can reduce the use of OGTT when women become pregnant at older ages.

BackgroundThere are little data about adverse effects and immunogenicity of flu vaccine in Asian pregnant women.MethodsThis prospective trial (NCT01514708) enrolled 46 pregnant women who received a single intramuscular dose of trivalent flu vaccine (AdimFlu-S®) containing 15 mcg of hemagglutinin for each strain/0.5 mL from influenza A (H1N1), influenza A (H3N2), and influenza B after the first trimester. Blood samples were collected at day 0 and 28 after vaccination, and at delivery. Cord blood was also collected. Hemagglutination inhibition (HAI) assays were performed to determine seroprotection and seroconversion rates and fold increase in the HAI geometric mean titer (GMT).ResultsTwenty-eight days after vaccination the seroprotection rate against H1N1, H3N2, and influenza B was 91.3%, 84.8% and 56.5%, respectively. The GMT fold increase was 12.8, 8.4, and 4.6 for H1N1, H3N2, and influenza B, respectively. At delivery, both the seroprotection rate (86.4%, 68.2%, and 47.7%) and GMT fold increase (9.4, 5.7 and 3.8) were slightly lower than day 28. The seroprotection rate and GMT fold increase in maternal and cord blood samples were comparable. No significant adverse effects were detected.ConclusionsTrivalent flu vaccine induces a strong immune response in pregnant women and their infants without adverse effects.Trial RegistrationClinical Trials. gov NCT01514708

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Abscess formation inside adenomyosis rarely occurred. A 49-year-old woman had adenomyosis for several years with the symptoms of menorrhagia and dysmenorrhea. She presented with fever of unknown etiology for 3 weeks. 67Ga SPECT/CT demonstrated increased tracer accumulation inside the uterus, which was confirmed as pyoadenomyosis after hysterectomy, and her fever subsided dramatically thereafter. For women with adenomyosis and fever of unknown origin, pyoadenomyosis is a rare but possible cause. 67Ga SPECT/CT is a valuable tool for accurate diagnosis.