OBJECTIVEPredictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester.RESEARCH DESIGN AND METHODSWe identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA]) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models.RESULTSCompared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P < 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non–laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017–0.115).CONCLUSIONSGDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA).

OBJECTIVETo investigate the association between first-trimester maternal serum levels of 25-hydroxyvitamin D (25-OH-D) as measured by liquid chromatography-tandem mass spectrometry and development of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSWe conducted a case-control study involving 248 women in the first-trimester of pregnancy, 90 of whom developed GDM and 158 remained normoglycemic.RESULTSAlthough booking 25-OH-D levels correlated negatively with 2-h glucose post-oral glucose tolerance test and positively with HDL cholesterol, as well as with ethnicity, obesity, and smoking (all P < 0.05), there were no statistically significant differences in baseline maternal mean 25-OH-D levels between those who subsequently developed GDM, 18.9 ng/mL (SD 10.7) and those who remained normoglycemic, 19.0 ng/mL (10.7) (P = 0.874), even after adjustment for possible confounders including sampling month (P = 0.784).CONCLUSIONSOur large and well-phenotyped prospective study did not find evidence of an association between first-trimester maternal levels of 25-OH-D and subsequent development of GDM.

Objective To examine the individual association between advancing maternal age, body mass index (BMI) and racial origin with the development of gestational diabetes mellitus (GDM) and the interaction between these factors.Design Retrospective study.Setting Fifteen maternity units in northwest London between 1988 and 2000.Population The study included 1688 women who developed GDM and 172 632 who did not. All women were nulliparous. BMI was calculated at first antenatal visit and maternal age and racial origin (White European, Black African, Black Caribbean or South Asian) were self-reported.Methods Binary logistic regression analysis.Main outcome measures Development of GDM within each racial group.Results There was a strong positive association between advancing maternal age and increasing BMI, individually, and the development of GDM (P < 0.01 for both). Compared with White Europeans aged 20-24 years, the odds ratios for GDM development were significantly higher in women older than 30 years if they were White Europeans (P < 0.001), older than 25 years if they were Black Africans (P < 0.001) and older than 20 years if they were South Asians (P < 0.001). The odds ratios for GDM development were significantly higher in Black Africans and South Asians (P < 0.001 for both) irrespective of BMI, compared with White Europeans with normal BMI.Conclusion Maternal age and BMI interact with racial group in relation to the prevalence of GDM. Both factors are important in the development of GDM, particularly so in Black African and South Asian women.

Objective To examine the effect of maternal characteristics, including advancing maternal age, body mass index (BMI), racial origin and development of gestational diabetes mellitus (GDM), on birthweight and the interactions between these factors.Design Retrospective analysis of prospectively collected data.Setting Fifteen maternity units in North West London, between 1988 and 2000.Population A cohort of 130 549 pregnant women.Methods Multivariate regression analysis.Outcome measures Birthweight z-scores in non-GDM and GDM groups within three main racial groups (white European, black and South Asian women).Results Babies born to women with GDM were heavier compared with those born to women with no GDM in all racial groups. In black women with GDM the birthweight z-scores were 0.805 higher, in South Asian women the scores were 0.618 higher and in white European women the scores were 0.437 higher, compared with the respective non-GDM group (P < 0.001 for both comparisons versus white European women), and these differences were much greater at high rather than at low maternal BMIs. Advancing maternal age, increasing BMI, highest diastolic blood pressure, Castair's index, racial group and presence of GDM or smoking were each, individually, significantly associated with birthweight z-scores (P < 0.001 for all variables). After adjusting for possible confounding factors, BMI was positively associated with birthweight z-scores within all racial groups (P < 0.001 for all), irrespective of glycaemic status, but its effect was much greater in women with GDM, particularly in those of non-White origin. After adjusting for possible confounding factors, advancing maternal age was only positively associated with birthweight in women of white European and South Asian racial origin who did not suffer from GDM (P < 0.001 for both).Conclusion Gestational diabetes mellitus strongly accentuates the effect of maternal BMI on birthweight, especially within nonwhite populations.

Low maternal vitamin D levels have been associated with adverse pregnancy outcome. A recent study has suggested that low maternal vitamin D levels at the time of delivery are also associated with an almost fourfold increase in caesarean section risk. The aim of the present study was to investigate whether there is a difference in maternal serum 25-hydroxyvitamin D (25(OH)D) levels at 11-13 weeks' gestation according to the mode of delivery. Maternal serum 25(OH)D levels were measured at 11-13 weeks' gestation in 995 singleton pregnancies resulting in the birth of phenotypically normal neonates at term. The measured 25(OH)D levels were adjusted for maternal age, BMI, racial origin, smoking, method of conception and season of blood testing, and the adjusted levels (multiple of the median; MoM) were compared between those who subsequently delivered vaginally and those that delivered by caesarean section. Delivery was vaginal in 79·6 % of cases, by emergency caesarean section in 11·6 % and by elective caesarean section in 8·8 %. The median 25(OH)D level in our population was 46·82 (interquartile range (IQR) 27·75-70·13) nmol/l. The adjusted maternal median 25(OH)D levels in the emergency and elective caesarean section groups (0·99, IQR 0·71-1·46 MoM and 0·96, IQR 0·73-1·27 MoM, respectively) were not significantly different from the vaginal delivery group (0·99, IQR 0·71-1·33 MoM; P¼ 0·53 and P¼0·81, respectively). First-trimester maternal serum 25(OH)D levels are similar between women who subsequently have a vaginal delivery and those who deliver by elective or emergency caesarean section. Key words: Vitamin D: Pregnancy: Caesarean section: Vaginal deliveryVitamin D has been implicated in the pathogenesis of CVD and diabetes mellitus (1,2) . Recent studies have also reported a link between maternal vitamin D deficiency and adverse pregnancy outcomes such as pre-eclampsia, gestational diabetes and small-for-gestational-age neonates (3 -5) .Vitamin D plays an important role in Ca homeostasis, bone mineralisation and muscle performance. The active metabolite of vitamin D, 1,25-dihydroxyvitamin D, binds to a vitamin Dspecific nuclear receptor in muscle tissue (6) , which leads to de novo protein synthesis, muscle cell growth (7) and improved muscle function (8) . A recent case-control study has reported that low maternal serum 25-hydroxyvitamin D (25(OH)D) concentration at the time of delivery was associated with an increased risk of caesarean section (emergency or elective) (9) , and this was attributed to the negative effect of vitamin D deficiency on muscle performance and uterine contractions.The aim of the present study was to assess further possible differences in maternal serum levels of 25(OH)D in the first trimester of pregnancy between women who subsequently have vaginal delivery compared with those who deliver by caesarean section. If vitamin D deficiency is associated with an increased risk of caesarean section due to suboptimal muscle function, this association would have been more marked in women...

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