Screening recommendations for gestational diabetes mellitus

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“…However, any alternative to universal screening may be problematic, as Cousins and colleagues 200 observed:…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Screening for gestational diabetes: a systematic review and economic evaluation

Scott

Loveman

McIntyre³

et al. 2002

Health Technol Assess

179

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“…Glucose tolerance tests and diagnostic criteria All women had a 50-g GCT at 16 -33 weeks of gestation, performed in the morning after a 12-h overnight fast (6). Fasting glucose was measured in venous whole blood, with a capillary whole blood glucose measurement 1 h later.…”

Section: Research Design Andmentioning

confidence: 99%

Determinants of Mild Gestational Hyperglycemia and Gestational Diabetes Mellitus in a Large Dutch Multiethnic Cohort

Weijers

Bekedam²,

Smulders³

2002

Diabetes Care

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OBJECTIVE -The purpose of this study was to identify independent determinants of mild gestational hyperglycemia (MGH) and gestational diabetes mellitus (GDM) and to assess the correlation between fasting glucose and C-peptide levels among control, MGH, and GDM women.RESEARCH DESIGN AND METHODS -A total of 1,022 consecutive women were evaluated with a 1-h 50-g glucose challenge test (GCT) at between 16 and 33 weeks of gestation. Women with a capillary whole-blood glucose Ն7.8 mmol/l in the GCT underwent a 3-h 100-g oral glucose tolerance test (OGTT). On the basis of a positive GCT, the women with a positive OGTT were classified as GDM, whereas the women with a negative OGTT were classified as MGH. The following data were collected for all women: age, prepregnancy BMI, ethnicity, clinical and obstetric history, pregnancy outcome, and C-peptide level.RESULTS -A total of 813 women (79.6%) were normal, 138 (13.5%) had MGH, and 71 (6.9%) had GDM. There was a stepwise significant increase in mean fasting glucose (3.6 Ϯ 0.4, 3.9 Ϯ 0.4, and 4.7 Ϯ 0.7 mmol/l, respectively) and C-peptide level (0.60 [0.1-2.4], 0.86 [0.3-2.0], and 1.00 [0.5-1.6] nmol/l, respectively) among the three diagnostic groups. Maternal age, non-Caucasian ethnicity, and prepregnancy BMI were associated with GDM, whereas only maternal age and prepregnancy BMI were associated with MGH. A positive correlation between levels of fasting glucose and C-peptide was found in control women (r ϭ 0.39 [95% CI 0.31-0.46]). A similar result was seen in MGH women (r ϭ 0.38 [95% CI 0.23-0.52]), whereas the correlation between fasting glucose and C-peptide was nearly lost in GDM women (r ϭ 0.14 [CI Ϫ0.09 to 0.36]). The fasting C-peptide-to-glucose ratio was reduced by 60% in GDM patients versus control subjects and MGH patients (0.41 Ϯ 0.25 vs. 0.70 Ϯ 0.20 and 0.73 Ϯ 0.23, P Ͻ 0.001).CONCLUSIONS -Of the well-known independent determinants of GDM, only maternal age and prepregnancy BMI were associated with MGH. It appears that additional factors promoting loss of ␤-cell function distinguish MGH from GDM. One of these factors appears to be ethnicity. Diabetes Care 25:72-77, 2002

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“…GLTs were performed at random times of day irrespective of meals and consisted of a 50-g oral glucose load followed by plasma gJucose measurement 60 minutes later; a plasma glucose level of 7.8 mmol/L or greater on this test is considered abnormal and an indication for a 3-hour oral glucose tolerance test to exclude gestational diabetes mellitus. 11 The study was approved by the Human Research Committee of Brigham and Women's Hospital.…”

Section: Subjectsmentioning

confidence: 99%

Glucose intolerance as a predictor of hypertension in pregnancy.

et al. 1994

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Insulin resistance is associated with and may be causal in essential hypertension, but the relation between insulin resistance and hypertension arising de novo in pregnancy is unclear. Transient hypertension of pregnancy (newonset nonproteinuric hypertension of late pregnancy) is associated with a high risk of later essential hypertension and thus may have similar pathophysiology. To assess the association between glucose intolerance and subsequent development of proteinuric and nonproteinuric hypertension in pregnancy in women without underlying essential hypertension or overt glucose intolerance, we performed a retrospective case-control study comparing glucose levels on routine screening for gestational diabetes mellitus among women subsequently developing hypertension. Women who developed hypertension in pregnancy (n=97) had significantly higher glucose levels on 50-g oral glucose loading test (P<.01) and a significantly higher frequency of abnormal glucose loading tests (^7.8 mmol/L) (P<.01) than women who remained normotensive (n=77). Relative glucose intolerance was particularly common in women who developed nonproteinuric hypertension. E ssential hypertension is associated with glucose intolerance and insulin resistance. 1 The observation of increased insulin resistance in normotensive offspring of hypertensive parents 2 suggests that insulin resistance precedes the development of essential hypertension and may be causal. Postulated mechanisms by which insulin resistance or hyperinsulinemia may predispose to hypertension include increased renal sodium reabsorption, 3 activation of sympathetic nervous system activity, 4 and stimulation of cell membrane cation transport. 5The role of insulin resistance in the pathogenesis of hypertension arising de novo in pregnancy has received little attention, but indirect evidence suggests it may be important. Pregnancy is a state of increased insulin resistance 6 ; hypertension in pregnancy characteristically presents in the third trimester when the insulin resistance normally accompanying pregnancy is greatest. Obesity, which is associated with a decreased sensitivity to insulin, may be a risk factor for hypertension in pregnancy. 7 In addition, an increased risk of hypertension in pregnancy has been reported in some studies of Women who developed hypertension also had greater prepregnancy body mass index (Ps.0001) and baseline systolic and diastolic blood pressures (Pi.0001 for both), although all subjects were normotensive at baseline by study design. However, after adjustment for these and other potential confounders, an abnormal glucose loading test remained a significant predictor of development of hypertension (P<.05) and, specifically, nonproteinuric hypertension in pregnancy (P<.01). Among a subgroup of women in whom insulin levels were also measured (n=80), there was a nonsignificant trend toward higher insulin levels in women developing hypertension. These results suggest that relative glucose intolerance is associated with an increased risk of new...

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Screening recommendations for gestational diabetes mellitus

Cited by 43 publications

References 16 publications

Screening for gestational diabetes: a systematic review and economic evaluation

Screening for gestational diabetes: a systematic review and economic evaluation

Determinants of Mild Gestational Hyperglycemia and Gestational Diabetes Mellitus in a Large Dutch Multiethnic Cohort

Glucose intolerance as a predictor of hypertension in pregnancy.

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