Gestational diabetes mellitus diagnosed during early pregnancy

Bartha, José Luis; Martinez-Del-Fresno, Pilar; Comino-Delgado, Rafael

doi:10.1016/s0002-9378(00)70222-5

Cited by 137 publications

(91 citation statements)

References 6 publications

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“…Our findings are also consistent with those of the single prospective cohort study in this field (23). This showed that women in whom GDM was diagnosed early (before 24 weeks of gestation) were more likely to be hypertensive, to have poorer glycemic control, and to have greater need for insulin therapy, with all cases of neonatal morbidity and mortality occurring in this cohort (23). Similar findings have been reported in retrospective cohort studies (24)(25)(26)(27); however, all these studies were limited by the heterogeneity of their early GDM cohorts.…”

Section: Discussionsupporting

confidence: 92%

“…This finding reflects that of the observational HAPO study (22), which identified the independent effect of both maternal adiposity and higher OGTT values in later pregnancy on LGA and macrosomia. Our findings are also consistent with those of the single prospective cohort study in this field (23). This showed that women in whom GDM was diagnosed early (before 24 weeks of gestation) were more likely to be hypertensive, to have poorer glycemic control, and to have greater need for insulin therapy, with all cases of neonatal morbidity and mortality occurring in this cohort (23).…”

Section: Discussionsupporting

confidence: 90%

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Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

et al. 2015

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OBJECTIVERecent guidelines recommend testing at <24 weeks of gestation for maternal dysglycemia in "high-risk" women. Evidence to support the early identification and treatment of gestational diabetes mellitus (GDM) is, however, limited. We examined the prevalence, clinical characteristics, and pregnancy outcomes of high-risk women with GDM diagnosed at <24 weeks of gestation (early GDM) and those with pre-existing diabetes compared with GDM diagnosed at ‡24 weeks of gestation, in a large treated multiethnic cohort. RESEARCH DESIGN AND METHODSOutcomes from 4,873 women attending a university hospital antenatal diabetes clinic between 1991 and 2011 were examined. All were treated to standardized glycemic targets. Women were stratified as pre-existing diabetes (n = 65) or GDM diagnosed at <12 weeks of gestation (n = 68), at 12-23 weeks of gestation (n = 1,247), or at ‡24 weeks of gestation (n = 3,493). RESULTSHypertensive disorders in pregnancy including pre-eclampsia, preterm delivery, cesarean section, and neonatal jaundice (all P < 0.001) were more prevalent in women with pre-existing diabetes and early GDM. Macrosomia (21.8% vs. 20.3%, P = 0.8), large for gestational age (39.6% vs. 32.8%, P = 0.4), and neonatal intensive care admission (38.5% vs. 39.7%, P = 0.9) in women in whom GDM was diagnosed at <12 weeks of gestation were comparable to rates seen in women with pre-existing diabetes. CONCLUSIONSDespite early testing and current best practice treatment, early GDM in high-risk women remains associated with poorer pregnancy outcomes. Outcomes for those in whom GDM was diagnosed at <12 weeks of gestation approximated those seen in pre-existing diabetes. These findings indicate the need for further studies to establish the efficacy of alternative management approaches to improve outcomes in these high-risk pregnancies.Gestational diabetes mellitus (GDM) is associated with significant transgenerational maternal and neonatal morbidity (1-3). The prevalence of GDM is rising, in part reflecting the changing demographics of women of childbearing age, with an increasing incidence of both obesity and advanced maternal age (4-6). These observations have important implications for the current GDM testing paradigm.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

et al. 2015

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“…In Europe, hospital-based studies were conducted in Spain and Italy. Three studies in Spain reported prevalence rates ranging from 3.3% to 8.8% using NDDG criteria (87,93,94). The two Italian studies report prevalence rates of 4.6% and 8.7% based on C & C criteria (88,95).…”

Section: Hospital-based Studiesmentioning

confidence: 99%

The Increasing Prevalence of Diabetes in Pregnancy

Hunt

Schuller

2007

Obstetrics and Gynecology Clinics of North America

420

272

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“…Gestational diabetes mellitus (GDM) affects 3-5% of women (Engelgau et al, 1998) and is associated with congenital malformations (Williams et al, 1999), perinatal mortality (Bartha et al, 2000), macrosomia (Langer & Hod, 1996) and organomegaly (Persson & Hanson, 1998). Women with a history of GDM and their offspring have a higher risk of developing blood lipid abnormality (dyslipidaemia), high blood pressure and diabetes later in life (Ko et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Plasma AA and DHA levels are not compromised in newly diagnosed gestational diabetic women

et al. 2004

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Objective: The polyunsaturated fatty acids, arachidonic (AA) and docosahexaenoic (DHA), are vital structural and functional components of the neural, vascular and visual systems. There is increased demand for these fatty acids during pregnancy. Diabetes impairs the synthesis of both AA and DHA. We have investigated the possibility that pregnancy-induced diabetes compromises the levels of plasma AA and DHA in newly diagnosed expectant mothers. Design: Cross-sectional study. Setting: London, UK. Subjects and methods: Venous blood was obtained from 44 women with gestational diabetes mellitus (GDM) and from the same number of nondiabetics, during the third trimester. Fatty acid composition of plasma choline phosphoglycerides (CPG), triglycerides (TG) and cholesterol esters (CE) was analysed. Results: The GDM women had higher levels of AA (20:4n-6; Po0.0001) and AA/linoleic acid ratio (20:4n-6/18:2n-6; Po0.01) in the CPG, and linoleic acid (LA; Po0.0001), total n-6 (Po0.01), DHA (Po0.05) and n-3 metabolites (Po0.05) in TG compared to their nondiabetic counterparts. Similarly, AA (Po0.0001), osbond acid (22:5n-6; Po0.05), total n-6 metabolites (Po0.0001), AA/LA (Po0.0001) and n-6 metabolites/LA (Po0.01) were higher in the CE of the GDM women. There was no difference in the levels of DHA in CPG and CE between the two groups (P40.05). Conclusions:The results of this study do not provide evidence that the activity of delta-6 or delta-5 desaturases, which are vital for the synthesis of AA and DHA, is compromised by pregnancy-induced diabetes. However, since the samples were taken at diagnosis, it is conceivable that the duration of the diabetes was too short to have a discernable adverse effect on the levels of AA and DHA in plasma lipids.

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Gestational diabetes mellitus diagnosed during early pregnancy

Cited by 137 publications

References 6 publications

Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment

The Increasing Prevalence of Diabetes in Pregnancy

Plasma AA and DHA levels are not compromised in newly diagnosed gestational diabetic women

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