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At least 19 recordsLinked to original sources
PubMed1987

Familial diabetes aggregation in type I diabetics: gestational diabetes an apparent risk factor for increased diabetes susceptibility in the offspring.

A significantly decreased familial diabetes aggregation on the maternal side of insulin-dependent diabetic children born between 1974 and 1984 as compared to those born between 1960 and 1973 was observed. This phenomenon was explained by an increased prevention of hyperglycaemia during pregnancy since 1974, particularly of gestational diabetes in women with familial diabetes aggregation. A highly significant predominance of Type II diabetes was found in great-grandmothers of infantile-onset diabetics on the maternal side as compared to the paternal side. This finding may suggest that gestational diabetes, which can represent a risk factor for diabetes transmission on the maternal side, is often followed by "extragestational" type II diabetes in higher age. This conclusion is supported by the data of familial diabetes aggregation obtained in insulin-dependent infantile- or juvenile-onset diabetics, when familial diabetes aggregation was ascertained as late as at least 20 years after birth of the diabetics. In this case, a significant predominance of familial diabetes aggregation in first- and second-degree relatives, particularly in grandmothers, was found on the maternal side as compared to the paternal side. All these findings are consistent with a teratogenetic effect of gestational diabetes on diabetes susceptibility in the offspring, which can be prevented by avoiding hyperglycaemia in pregnant women and hyperinsulinism in foetuses.

Adolescent↗
PubMedDate not supplied

Gestational diabetes.

Gestational diabetes is a condition that complicates 0.15% to 12.3% of pregnancies, with wide variation in the incidence of gestational diabetes reported among ethnic groups. When gestational diabetes occurs, health implications occur for the mother and infant not only during pregnancy and birth but for the long term as well. This article reviews what is known about gestational diabetes and presents an overview of carbohydrate metabolism in normal pregnancies and those complicated by gestational diabetes. A review of recent research and advances in the field focusing on the screening, diagnosis, and treatment of gestational diabetes is also provided. The most important aspect of gestational diabetes management is client participation. Recommended education and counseling for women with gestational diabetes is discussed for pregnancy, labor and birth, postpartum, and long-term follow-up. Although medical consultation is necessary in these pregnancies, many nurse-midwives continue to provide care for women with gestational diabetes. Appropriate nurse-midwifery management of women with gestational diabetes is emphasized.

Carbohydrate Metabolism↗
PubMed1996

Measurement of glucose metabolism and insulin secretion during normal pregnancy and pregnancy complicated by gestational diabetes.

Gestational diabetes affects 2-3% of pregnant women and is associated with foetal complications including macrosomia and an increased likelihood of developing diabetes in later life. We have therefore studied seven women with gestational diabetes and five control women both during the third trimester of pregnancy and again 2-3 months post-partum, using the minimal model analysis of the frequently sampled labelled ([6,6-2H2]-glucose) intravenous glucose tolerance test. Glucose tolerance (glucose Kd) was significantly reduced in the women with gestational diabetes compared with the normal pregnant women both in pregnancy (1.16 +/- 0.11 vs 1.78 +/- 0.23%/min; p < 0.05) and post-partum (1.47 +/- 0.22 vs 2.59 +/- 0.43%/min; p < 0.05) and increased significantly in the control women after delivery (p < 0.05). Glucose effectiveness was not significantly different between the women with gestational diabetes and the control group either during or after pregnancy. Insulin sensitivity was significantly lower during pregnancy than after delivery in the women with gestational diabetes (p < 0.05). There was no significant difference in basal insulin secretion in the two groups during pregnancy or post-partum. However, during pregnancy the control subjects significantly increased (p < 0.001) their insulin secretion over a period of 20 min in response to an intravenous glucose tolerance test (96.2 +/- 42.7 pmol/kg) compared with post-partum values (58.3 +/- 25.2 pmol/kg) while in the women with gestational diabetes insulin secretion was similar in pregnancy (65.5 +/- 9.3 pmol/kg) and after delivery (57.7 +/- 15.7 pmol/kg). These data suggest that the glucose intolerance in gestational diabetes compared to normal pregnancy is due to reduced insulin sensitivity and an impaired ability in gestational diabetes to increase insulin secretion in response to glucose.

Adult↗
PubMed1990

[Gestational diabetes].

Gestational diabetes defined by either glucose intolerance or overt diabetes discovered during pregnancy is a real nosologic entity which is associated with risks for both foetus and mother. Unfortunately biological definition of gestational diabetes remains controversial. In North America it is defined by O'Sullivan's criteria (OGTT with 100 g of glucose for 3 hours), in Europe it is defined by WHO's criteria (OGTT with 75 g of glucose for 2 hours). Strategy for selection of high risk women who have to be submitted to OGTT is also matter of debate. Despite these uncertainties, everybody agrees that gestational diabetes is associated with high risk of foetal macrosomia and high rate of cesarean section. For the mother, gestational diabetes is a marker of future development of diabetes. Most of gestational diabetes are related to type II diabetes but some cases of type I diabetes are preceded by gestational diabetes. The treatment of gestational diabetes depends upon the severity of glucose intolerance. It is resumed by dietetic intervention associated, if necessary, with insulin therapy.

Blood Glucose↗
PubMed1988

Postpartum testing for antecedent gestational diabetes.

Gestational diabetes is a predictor of glucose intolerance in subsequent pregnancies and in the nongravid state. Many pregnant women are not tested for gestational diabetes, although they or their offspring may show signs suggestive of antecedent hyperglycemia. We examined the diagnostic utility of a postpartum (within 48 hours), 100 gm, oral glucose tolerance test and cord plasma glucose, cord plasma C-peptide, and 2-hour neonatal plasma glucose tests to detect antecedent gestational diabetes in women with documented gestational diabetes (n = 37) or with normal glucose tolerance test results late in the third trimester (n = 28). The 1-hour, 2-hour, and incremental 1-hour + 2-hour [( 1-hour - fasting] + [2-hour - fasting]) [2-hour - fasting]) glucose values of the postpartum glucose tolerance test showed significant differences between study participants with and without gestational diabetes (164 +/- 30 versus 115 +/- 22, 145 +/- 31 versus 101 +/- 21, and 153 +/- 51 versus 67 +/- 33 mg/dl, respectively, p less than 0.025). Maternal fasting and 3-hour postpartum glucose tolerance test glucose, cord plasma glucose, cord plasma C-peptide, and 2-hour neonatal plasma glucose values showed no significant between-group differences. Receiver operating characteristic curve analyses for these tests indicated that the incremental 1-hour + 2-hour postpartum glucose tolerance test glucose values best sustain test specificity at the low test threshold values necessary for high test sensitivity. A threshold of 110 mg/dl for this test yielded a predicted specificity of 90% and sensitivity of 80% with regard to antecedent gestational diabetes.

Birth Weight↗
PubMed2003

[Gestational diabetes].

Gestational diabetes represents 6% of all pregnancies and appears even in women without risk factors. This is in favour of a systematic screening between 24th and 28th weeks of gestation. There is as yet still no consensus concerning screening and diagnosis criteria but in France the guidelines are a two step approach: an O'Sullivan test > or = 7.15 mmol/L and a 100 g oral glucose tolerance test (OGTT). Gestational diabetes is defined by 2 or more abnormal values of the OGTT (Carpenter and Coustan criterias). Gestational diabetes has feto-maternal implications: on the one hand gravid hypertension and caesarean section, on the other hand macrosomia, respiratory distress and metabolic complications. The therapeutic management is first diet but insulin therapy is necessary in 40% of cases to obtain glycemic control. During the second part of pregnancy, to obtain a normoglycaemia can decrease and even normalise the rate of feto-maternal complications. Long-term management of women with gestational diabetes and treatment modalities also require better definition, since these patients are at risk for diabetes, mainly type 2. Diabetologists have to set prevention programs up.

Diabetes, Gestational↗
PubMed1996

Diagnosis and management of gestational diabetes.

Gestational diabetes affects 3 to 6 percent of all pregnancies. Proper screening, diagnosis and management of this condition can reduce both maternal and neonatal morbidity. Family physicians can readily manage most patients with gestational diabetes by prescribing an appropriate diet, encouraging regular exercise and providing careful follow-up with regular glucose monitoring for the remainder of the pregnancy. Up to 90 percent of these patients do not need more intensive therapy. Since patients with gestational diabetes are at high risk for developing type II (non-insulin-dependent) diabetes mellitus later in life, they should be counseled and tested during the postpartum period and encouraged to lose weight (if necessary) and follow a diet to minimize the development of glucose intolerance.

Adult↗
PubMed1995

Pancreatic disorders of pregnancy. Diagnosis, management, and outcome of gestational diabetes.

Gestational diabetes is one of the more common medical problems of pregnancy. This article reviews the literature regarding the diagnosis and treatment and the controversy that surrounds gestational diabetes. The need for stricter guidelines for diagnosis and treatment and the evidence supporting this need are presented. Long-term follow-up evaluation for women with gestational diabetes and for their children is discussed.

Diabetes, Gestational↗
PubMed1996

Expression of inducible nitric oxide synthase in placenta of women with gestational diabetes.

Gestational diabetes is one of the most prevalent medical complications of pregnancy and causes increased fetal wastage. Investigation of placentas from diabetic mothers indicate chronic disturbances in intervillous, circulation, dilatation of capillaries, and a relatively immature villous structure. Abnormal levels of nitric oxide (NO) may contribute to maternal disorders such as the pathogenesis of diabetic vascular complications. In the normal placenta NO is generated only by endothelial NOS, which apparently serves to regulate vascular tone in the fetoplacental circulation. In contrast, studies have reported the absence of inducible nitric oxide synthase (iNOS) in human placentas under normal conditions. The aim of our study was to investigate whether iNOS is expressed in placentas from patients with gestational diabetes. Reverse transcription-polymerase chain reaction and Western blot analysis demonstrated iNOS mRNA and protein expression in placental tissue only from patients with gestational diabetes. Immunohistochemistry localized iNOS staining to endothelial cells and trophoblasts. We conclude that iNOS can be expressed in human placenta. Its expression might play an important role in placental pathophysiology.

Base Sequence↗
PubMed1997

[Peptide C and insulin after delivery in women with gestational diabetes].

Gestational diabetes is a disease appearing in many forms. Up till now the etiopathogenesis was not clearly defined. It has been suggested that counterregulatory of pregnancy or diminished B-cells could the major contributory factors. The aim of the present study was to retrospective verify the diagnoses of gestational diabetes. The investigation was carried out in 42 women aged 25-39 yrs, mean age 30 +/- 6 yrs. Diabetes was diagnosed in the 2nd, and 3rd, trimesters of pregnancy, 30 women were treated by diet only, 25 kcal/kg b.w. depending on weight, and 12 patients had intensified insulin therapy of mean daily dose 18 +/- 8 U. Three to nine months after delivery a glucose tolerance test as well as estimation of C-peptide and insulin concentration by RIA in basic conditions and after administration of 1 mg of glucagon were performed. In the group of women treated by diet only, normal values of glycaemia in glucose tolerance test were observed. C-peptide concentration measured before administration of glucagon was 1.15 +/- 0.49 ng/ml and after administration of 1 mg of glucagon was 3.14 +/- 1.44 ng/ml. In the majority of patients treated during pregnancy with insulin the results of oral glucose tolerance test were pathological. The concentrations of C-peptide in the test with glucagon were significantly lower (0.33 +/- 0.16 and 0.38 +/- 0.32 ng/ml). The concentrations of insulin were much lower in comparison to women treated with diet and healthy controls, these results suggest that, if gestational diabetes could be controlled by diet only, disturbances of carbohydrate metabolism would disappear, however, if insulin therapy was necessary during pregnancy, disturbances of the carbohydrate metabolism would be prolonged.

Adult↗
PubMed1994

Maternal implications of gestational diabetes.

Gestational diabetes encompasses a variable spectrum of decompensated glucose tolerance, with a substantial risk for developing future NIDDM. Several easily identifiable risk factors for subsequent diabetes have been identified, notably elevated fasting glucose levels during pregnancy, early diagnosis of gestational diabetes, and obesity. By continuing to identify independent risk factors during pregnancy and in the puerperium, we can develop better intervention programs and medical therapy to prevent or delay the onset of diabetes. Glucose tolerance testing in the postpartum period followed up by annual glucose surveillance for diabetes should be performed in all women with prior GDM. They should be actively educated about their high risk of diabetes and strongly encouraged to continue their diabetes and strongly encouraged to continue their diabetic diet, achieve an ideal body weight, and implement an exercise program. Combining such a program of preventive care with contraceptive visits contributes to a complete health care program for women with prior GDM during their reproductive years.

Diabetes, Gestational↗
PubMed2002

Current controversies in the mechanisms and treatment of gestational diabetes.

Gestational diabetes mellitus (GDM) is a heterogeneous entity, including carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Insulin resistance and beta-cell dysfunction are thought to be major determinants of its development. Its pathomechanism in many ways resembles that of type 2 diabetes. There is an evolving body of evidence from the last decade presenting similarities between gestational diabetes and the metabolic (insulin resistance) syndrome. These new observations suggest that GDM might be an early manifestation of the metabolic syndrome. The desired treatment target of GDM is normoglycemia. It can be reached by dietary treatment; however, if it fails, maternal glycemic monitoring or combined fetal-maternal monitoring, or even insulin (if required) can help reach it. Multiple daily insulin regimens are becoming more widely accepted for the treatment of GDM. Insulin analogues, however, need some more evidence to support their usefulness and safety during pregnancy. The screening for GDM, the reclassification, regular care, and follow-up of these women after pregnancy are of the utmost importance to delay or prevent not only type 2 diabetes but cardiovascular complications as well.

Autoimmune Diseases↗
PubMed1993

Detecting and managing gestational diabetes.

Gestational diabetes is an asymptomatic metabolic disorder of pregnancy associated with increased morbidity in mother and fetus. Early detection and intervention improve pregnancy outcome. This article reviews the current approach to diagnosis and management. Specific guidelines for nutritional management and insulin use are included.

Clinical Protocols↗
PubMed1981

Placental immunopathology in gestational diabetes.

Gestational diabetes and insulin-dependent diabetes are characterized by distinct pathophysiological mechanisms. However, their presence in pregnancy poses similar risks to the fetus. It is possible that factors common to both diseases are responsible for the increased morbidity and mortality in offspring of such pregnancies. Recent studies of placentae from insulin-dependent diabetics revealed evidence of immunopathological change which may support the possible role of immunological factors in the complications of diabetic pregnancy. In the present study, we have similarly examined placentae derived from 30 pregnancies complicated by gestational diabetes and from 10 normal pregnancies. The most striking differences detected by immunofluorescence were increased amounts of clotting factors related to areas of fibrinoid necrosis, and large quantities of complement components C4 and C3 in the intervillous spaces and trophoblast basement membrane respectively. These results are similar to those found in placentae from insulin-dependent diabetics, suggesting that glucose intolerance in pregnancy, even of minor degree, is frequently associated with immunopathological processes that are reflected in the placenta.

Animals↗
PubMed2004

Screening and diagnosis of gestational diabetes.

Gestational diabetes mellitus (GDM) is a risk factor for the mother and foetus. The risks increase proportionally to the maternal blood sugar concentration along a glycaemic continuum. However, there is ongoing controversy about the objectives of active screening and diabetic and obstetrical management for GDM. Various screening and diagnostic tests are used. None of them offers the combination of qualities to be expected from a test: simplicity of use, reproducibility, specificity and sensitivity, but each of them provides a basis on which recommendations can be established. The need to screen GDM as a risk factor in the whole population of pregnant women has led us to propose the use of simple, universally applied test, such as the "practical" test constituted by the assay of fasting and post-prandial blood glucose levels. In addition to screening, a classification which will take into account the results of subsequent as well as initial blood glucose levels could be preferable to evaluate the management and results.

Blood Glucose↗
PubMed2004

Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes.

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.

Congenital Abnormalities↗
PubMed2004

The clinical impact of screening for gestational diabetes.

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance during pregnancy. In Denmark the health service offers selective screening for GDM, i.e., admission to an oral glucose tolerance test (OGTT) after pre-screening with interview for clinical risk factors for GDM, two capillary fasting blood glucose (cFBG) measurements and a urine test for glucosuria. The aim of the present study was to investigate the power of the pre-screening to identify GDM and the screening to predict adverse clinical outcome. A retrospective investigation of pregnant women undergoing screening during 1998 at Vejle County Hospital, Denmark was undertaken. The two most frequent pre-screening criteria for OGTT were body-mass index (BMI) > or = 27 kg/m2 and age > or = 35 years. The highest odds ratio (OR) of 9.07 (95% CI: 2.60 to 63.70) for GDM had glucosuria and the lowest (zero) had cFBG. The frequency of complicated delivery was similar in GDM (58%) compared to non-GDM (56%). The best predictor of complicated delivery was a BMI with OR = 1.50 (95% CI: 0.87 to 2.60) for BMI > or = 27 kg/m2 vs. < 27 kg/m2. The best predictor of adverse neonatal outcome was a capillary blood glucose 120 min after glucose load (cBG(120 min)) > or = 9.0 mmol/l (OR = 3.18, 95% CI: 1.14 to 8.89). The intermediary endpoint GDM was not superior for predicting adverse maternal and neonatal outcome. The cumulative probability distribution of cBG(120 min) after a 75 g glucose load was not homogeneously distributed in groups stratified according to maternal and foetal outcome. A changed slope was seen after cBG(120 min) 9.0 mmol/l. Screening cFBG of 4.1 mmol/l was unable to predict GDM and adverse outcome. Glucosuria was too rare to be effective as a screening tool. Pre-screening did not identify GDM. The best predictor of complicated delivery was a high BMI. The best predictor of foetal adverse outcome was cBG120 miin > or = 9.0 mmol/l after a 75 g glucose load. Identical fraction complications were present in GDM and non-GDM. A refinement of the screening procedure is highly needed, and this has been initiated in Denmark.

Adult↗
PubMed1995

Defects in insulin secretion and action in women with a history of gestational diabetes.

Gestational diabetes mellitus (GDM) is associated with defects in insulin secretion and insulin action, and women with a history of GDM carry a high risk for the development of non-insulin-dependent diabetes mellitus (NIDDM). Assessment of subjects with a history of GDM who are currently normoglycemic should help elucidate some of the underlying defects in insulin secretion or action in the evolution of NIDDM. We have studied 14 women with normal oral glucose tolerance who had a history of GDM. They were compared with a group of control subjects who were matched for both body mass index (BMI) and waist-to-hip ratio (WHR). All subjects underwent tests for the determination of oral glucose tolerance, ultradian oscillations in insulin secretion during a 28-h glucose infusion, insulin secretion in response to intravenous glucose, glucose disappearance after intravenous glucose (Kg), and insulin sensitivity (SI) as measured by the Bergman minimal model method. The BMI in the post-GDM women was similar to that in the control subjects (24.9 +/- 1.2 vs. 25.4 +/- 1.4 kg/m2, respectively), as was the WHR ratio (0.80 +/- 0.01 vs. 0.76 +/- 0.01, respectively). The post-GDM women were slightly older (35.2 +/- 0.9 vs. 32.1 +/- 1.4 years, P = 0.04). The fasting plasma glucose levels were significantly higher in the post-GDM group than in the control group (4.9 +/- 0.1 vs. 4.4 +/- 0.1 mmol/l, respectively, P < 0.001) and remained higher at each of the subsequent determinations during the oral glucose tolerance test, although none had a result indicative of either diabetes or impaired glucose tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

Activity Cycles↗