OBJECTIVEWe aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI ≥25 kg/m2, age ≥35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia.RESEARCH DESIGN AND METHODSOf 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level ≥5.3 mmol/L and/or 2-h postload (75 g) glucose level ≥7.8 mmol/L.RESULTSThe prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associated with GDM (odds ratio 1.4 [95% CI 1.3–1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%.CONCLUSIONSThe presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines.

No abstract

No abstract

No abstract

Although women with GDM are considered to be highly motivated, SMBG adherence and reliability are of concern and may be associated with poor gestational prognosis, suggesting that caregivers should systematically check the glucose meter memory to improve GDM management.

languages. Three months postpartum, women were mailed the Impact of Event Scale (IES) questionnaire, which measures posttraumatic stress symptoms. Demographics and obstetric characteristics were collected from medical records. Statistical analysis was by w 2 test and stress symptoms were analyzed by forward, stepwise logistic regression.The scores showed that 41 (33%) of the women had a low SOC; 68 (56%) had a moderate SOC; and 13 (11%) had a high SOC. There was no significant association between low SOC and age or parity, but it was more frequent in women who were born abroad (P = 0.045), had undergone a previous EMCS or vacuum extraction (P = 0.045), were single (P = 0.025), had a low socioeconomic background (P = 0.002), or had received antenatal counseling due to fear of childbirth (Pr0.001). Posttraumatic stress symptoms (IES) were seen to be normal in 80 (66%) women, moderate (needing follow-up) in 31 (25%), and severe in 11 (9%). Two independent risk factors for more than normal symptoms of posttraumatic stress were a low SOC and imminent fetal asphyxia as the main indication for the EMCS. One factor appeared to be protective for these symptoms: full cervical dilation at the time of the CS (P = 0.022).In this study, symptoms of posttraumatic stress disorder following EMCS were associated both with the personal coping style of the mother and the circumstances of the event. The authors suggested that an antenatal SOC evaluation could help determine who will need more follow-up or support. Especially vulnerable are women with a low SOC (eg, with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women) and those in whom imminent asphyxia is an indication for the operation.L aparoscopic adjustable gastric banding (LAGB) has been used with greater frequency to control obesity among women of childbearing age. Little data on obstetric and neonatal outcomes in women after LAGB exist. This retrospective case-control study evaluated obstetric and neonatal outcomes in women who became pregnant after LAGB (13 cases) compared with obese women who did not undergo LAGB (14 controls). Data were gathered from a single institution in France. Women for the control group all had body mass indexes (BMIs) >30 kg/m 2 . Antepartum variables included age, race, parity, weight and BMI before LABG, weight loss before pregnancy, BMI at beginning of pregnancy, and history of cesarean delivery. Intrapartum variables were maternal weight gain during pregnancy, preterm delivery, presence of preeclampsia, gestational hypertension, or gestational diabetes mellitus, and labor and its complications. Neonatal outcomes were low birth weight (<2500 g), small for gestational age, macrosomia, Apgar score at 5 minutes, and umbilical artery blood gas analysis.All women had singleton pregnancies. The mean weight and BMI in the LAGB group were 95.2 ± 11.6 kg and 34.8 ± 3.2 kg/m 2 ; mean weight and BMI in the controls were 92.4 ± 12.8 kg and 35 kg/m 2 . The mean maternal weight gain was 5.5 kg in LAGB women compar...

Among obese women, the incidence of adverse obstetric outcomes was less in those who underwent LABG than in those who did not. These results suggest that obese women who wish to become pregnant would decrease their risk of obstetric complications if they first underwent LAGB.

Standard selective screening criteria were not predictive of GDM in women from India-Pakistan-Sri Lanka and Asia and were associated with GDM-related events only in European and North African women. However, the women with GDM, who were routinely treated, had a poor prognosis, even for those free of RFs. These results support universal screening, irrespective of ethnicity.