Screening for Gestational Diabetes: Optimum Timing and Criteria for Retesting

Jovanovič, Lois; Peterson, Charles M.

doi:10.2337/diab.34.2.s21

Cited by 81 publications

(29 citation statements)

References 5 publications

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“…The observation that gestational diabetes is not associated with a higher risk of hypospadias is consistent with this idea, because gestational diabetes usually develops after these key steps in urethral development have been completed. 19 Finally, in contrast to a previously published report that indicated that the prevalence of hypospadias in the United States was increasing, 11 we observed relatively stable rates of hypospadias in Washington State from 1987 though 2002. However, as noted previously, the ICD-9 classification of hypospadias changed in 1996, which might in part account for the dip in prevalence between 1996 and 1997 (Fig 1).…”

contrasting

confidence: 55%

Hypospadias in Washington State: Maternal Risk Factors and Prevalence Trends

Porter

Faizan

Grady³

et al. 2005

Pediatrics

101

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ABSTRACT. Objective. Maternal risk factors for hypospadias are poorly defined, and there is debate about temporal trends in hypospadias prevalence. We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State.Methods. We performed a population-based, casecontrol study using linked birth-hospital discharge data from Washington State for 1987-1997 and prevalence data for 1987-2002. All cases of hypospadias were identified on the basis of International Classification of Diseases, Ninth Revision, codes from the birth hospitalization (N ‫؍‬ 2155). Five control subjects were randomly selected for each case subject from the remaining singleton births, frequency matched according to year of birth (N ‫؍‬ 10 775). Maternal and infant characteristics were ascertained from the birth certificate. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year.Results. The risk of delivering an affected male infant increased with advancing maternal age; relative to women <20 years of age, those >40 years of age were at greatest risk (OR: 1.70; 95% CI: 1.17-2.48). Infants of nonwhite women were generally at decreased risk. Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes (OR: 2.18; 95% CI: 1.03-4.60); however, this was not observed for infants born to women with gestational diabetes. The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births, not significantly different from that in 1987.Conclusion. Older maternal age, white race, and preexisting diabetes were associated with increased risk of hypospadias among male offspring. H ypospadias is one of the most common congenital anomalies in the United States, with an estimated prevalence of 3 to 8 cases per 1000 male births. 1,2 The malformation is the result of incomplete fusion of the urethral folds, which usually occurs between 9 and 12 weeks of gestation. Although the success rate for surgical repair is high, 3 the high prevalence of hypospadias translates into a significant financial burden on the health care system. When rare complications do occur, the resultant morbidity of corrective procedures, psychologic stress, and potential loss of function can be devastating to the patient and family.Although hypospadias is common, risk factors for this birth defect are relatively poorly defined. Familial aggregation is well recognized. 4 It has been established that low birth weight and shorter gestation are associated with hypospadias, 5-7 but other risk factors are more controversial. At least 2 studies have suggested that older maternal age may be a risk factor for hypospadias, 1,8 but both of those studies relied on data from the same birth defects registry. Studies that examined race as a potential risk factor have...

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contrasting

confidence: 55%

Hypospadias in Washington State: Maternal Risk Factors and Prevalence Trends

Porter

Faizan

Grady³

et al. 2005

Pediatrics

101

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“…A slightly later approach to the initial screening (26 -30 vs. 24 -28 gestational weeks) was used (12). This approach has been shown to increase the yield of the screening (13). Additionally, retesting women at risk of GDM at a later gestational age was not feasible under the local antenatal care setting.…”

Section: Methodsmentioning

confidence: 99%

Women With Impaired Glucose Tolerance During Pregnancy Have Significantly Poor Pregnancy Outcomes

Yang

Hsu-Hage

Zhang³

et al. 2002

Diabetes Care

165

102

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OBJECTIVE -This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance. RESEARCH DESIGN AND METHODS-From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26 -30 gestational weeks. Women with a serum glucose Ն7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization's diagnostic criteria for GDM were used.RESULTS -Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90 -34.93); preterm birth (6.42; 1.46 -28.34); breech presentation (3.47; 1.11-10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07-5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors.CONCLUSIONS -The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.

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“…All patients gave oral, informed consent to participate in the study. A total of 949 pregnant women attending the centers as outpatients for routine prenatal clinical care were screened with the 50 g, 1-h glucose challenge test (GCT) (13 ) and Hb A 1c measurements. GCT was usually performed between the 24th and 27th weeks of pregnancy (range, 15-36 weeks), and Hb A 1c was measured on the same day.…”

Section: Materials and Methods Study Participantsmentioning

confidence: 99%