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OBJECTIVE--The International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain. RESEARCH DESIGN AND M|THODS--We conducted a retrospective study of 9,835 women who delivered at ≥ 20 weeks; gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight _+ GDM, and obese ± GDM RESULTS--Overall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups. CONCLUSIONS--Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant., Both International Association of Diabetes in Pregnancy Study Groups (IADPSG)-defined gestational diabetes mellitus (GDM) (1,2) and maternal overweight and obesity (2-4) are associated with increased risk for adverse maternal and [...]

Evaluation of glycemia is used for the diagnosis and management of patients with diabetes. Glucose and hemoglobin [A.sub.1c] ([HbA.sub.1c]) provide complementary information and both are used to assess an individual's [...]

BACKGROUND--Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH--An [...]

Diabetes was originally identified by the presence of glucose in the urine. Almost 2,500 years ago it was noticed that ants were attracted to the urine of some individuals. In [...]

OBJECTIVE--Serial measurements of the fetal abdominal circumference have been used to guide metabolic management of pregnancies complicated by gestational diabetes mellitus (GDM). A reduction in the number of repeat ultrasound [...]

OBJECTIVE--To examine the association between levels of hyperglycemia, determined by each prenatal oral glucose tolerance test (OGTT) value (fasting, 1 and 2 h), and maternal and perinatal outcomes and to [...]

OBJECTIVE--To estimate the prevalence of postpartum glucose testing within 6 months of pregnancies complicated by gestational diabetes mellitus (GDM), assess factors associated with testing and timing of testing after delivery, [...]

OBJECTIVE--The purpose of this study was to assess changes in the prevalence of preexisting diabetes (diabetes antedating pregnancy) and gestational diabetes mellitus (GDM) from 1999 through 2005. RESEARCH DESIGN AND [...]

The Fifth International Workshop-Conference on Gestational Diabetes Mellitus (GDM) was held in Chicago, IL, 11-13 November 2005 under the sponsorship of the American Diabetes Association. The meeting provided a forum [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.07.042 Byline: David A. Sacks (a), Amy I. Liu (b), Girma Wolde-Tsadik (b), Saeid B. Amini (c), Larraine Huston-Presley (c), Patrick M. Catalano (c) Abstract: This study was undertaken to determine the proportion of birth weight attributable to glucose concentrations of diabetic mothers. Author Affiliation: (a) Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, CA (b) Department of Research, Southern California Permanente Medical Group, Pasadena, CA (c) Department of Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH Article History: Received 5 February 2005; Revised 21 June 2005; Accepted 6 July 2005 Article Note: (footnote) Reprints not available from the author.

A study was conducted to determine the proportion of birth weight attributable to glucose concentrations of diabetic mothers. The results revealed that the maternal glycemia during third-trimester and prepregnancy body mass index are independent predictors of birth weight in pregnancies complicated by insulin requiring gestational or type 2 diabetes.

Monitoring of glycemic status, as performed by patients and health care providers, is considered a cornerstone of diabetes care. Results of monitoring are used to assess the efficacy of therapy [...]

Background: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. [...]

Blood sugar levels may not be the same when measured at the exact same time after a meal depending on when the meal is eaten. In a study of 30 women with gestational diabetes, blood sugar levels were not the same after an evening meal than at the same time interval after a morning meal.

Byline: David A. Sacks, Wansu Chen, Girma Wolde-Tsadik, Thomas A. Buchanan Keywords: Fasting; gestational diabetes; glucose Abstract: Objective: The object of the study was to determine whether time of day, interval after a standard meal, and maternal body mass influence plasma glucose concentrations in women with gestational diabetes mellitus. Study Design: Identical mixed meals were administered on 2 separate occasions 1 week apart to 30 women with dietarily treated gestational diabetes and pregnancies between 28 and 38 weeks' gestation. One meal was administered at 7 AM (morning meal) and the other was administered at 9 PM (evening meal), each after a fast of [greater than or equal to]5 hours. The order of the meals (morning first versus evening first) was assigned randomly. Sixteen of the women had a body mass index [greater than or equal to]27 kg/m.sup.2 (overweight) and 14 women had a body mass index Author Affiliation: Bellflower, Pasadena, and Los Angeles, California From the Department of Obstetrics and Gynecology, Kaiser Foundation Hospital,.sup.a the Department of Research and Evaluation, Southern California Permanente Medical Group,.sup.b and the Departments of Obstetrics and Gynecology and Internal Medicine, University of Southern California..sup.c Article Note: (footnote) [star] Reprint requests: David A. Sacks, MD, Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, 9400 E Rosecrans Ave, Bellflower, CA 90706., [star][star] 0002-9378/99 $8.00 + 0 6/6/101078

Glycation is the nonenzymatic attachment of a monosaccharide to amino groups of proteins. The reaction has been recognized for many years in the food industry, where it is known as [...]

Less rigorous control of glucose levels during pregnancy in type 1 diabetics than in women with type 2 diabetes may not increase complications, and could decrease the incidence of dangerously low glucose levels. In 46 pregnant women with type 1 diabetes, average glucose levels were higher, with target values achieved less often, compared to 113 pregnant women with type 2 diabetes. There were no statistical differences between the groups with respect to final maternal or neonatal outcome, but the incidence of severe low blood sugar was much higher in the women with type 1 diabetes.

Byline: David A. Sacks, Wansu Chen, Jeffrey S. Greenspoon, Girma Wolde-Tsadik Keywords: Pregestational diabetes; glucose; diabetes in pregnancy Abstract: Objective: Our purpose was to determine whether the same maternal glycemic control is necessary to achieve similar perinatal outcomes for type 1 as for type 2 diabetics. Study Design: The subjects were all women with pregestational diabetes mellitus delivered of live-born singletons. Glycemic control was achieved with diet and insulin. Self-monitoring of blood glucose was performed before meals and at bedtime. Target glucose values were 60 to 90 mg/dl fasting and 60 to 105 mg/dl at other times. Results: Of 60,628 deliveries, 46 type 1 and 113 type 2 diabetic women met inclusion criteria. Respective differences were found between type 1 and type 2 diabetics in average daily glucose levels (112 mg/dl vs 97 mg/dl, p < 0.001), percent of values within target ranges (35% vs 57%, p < 0.001), and mean amplitude of glycemic excursion (48.1 mg/dl vs 24.9 mg/dl, p < 0.001). At least one daily glucose value was Author Affiliation: Bellflower, Pasadena, and Los Angeles, California Article Note: (footnote) [star] From the Department of Obstetrics and Gynecology, Kaiser Foundation Hospital,a the Department of Research and Evaluation, Southern California Permanente Group,b and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center.c , [star][star] Reprint requests: David A. Sacks, MD, Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, 9400 Rosecrans Ave., Bellflower, CA 90706., a 0002-9378/97 $5.00 + 0 6/6/84377

Insulin resistance (IR) is a characteristic feature of noninsulin-dependent diabetes mellitus (NIDDM) as well as obesity, and a majority of NIDDM patients are obese. To assess the effect of obesity [...]

A set of values are proposed for diagnosing gestational diabetes via a 2-hour 75-g glucose tolerance test given between 24 and 28 weeks gestation, although these values do not constitute a threshold at which adverse neonatal outcomes appear or markedly increase. A group of 3505 pregnant women were administered a 2-hour 75-g glucose tolerance test. Women with values diagnostic of frank diabetes were excluded. The values were compared with birth weight because large birth weight is associated with diabetes in pregnancty. The following factors associated with increased birth weight: maternal race, number of pregnancies, height-to-weight ratio before pregnancy, pregnancy weight gain, length of pregnancy at time of testing, fasting plasma glucose value, and 2-hour glucose value after ingesting glucose. Birth weight tended to increase with increasing glucose values, but no threshold could be identified. The values proposed are offered because due to lack of clinically meaningful thresholds, consensus is the only way to establish diagnostic criteria for gestational diabetes.

OBJECTIVE--To report frequencies of gestational diabetes mellitus (GDM) among the 15 centers that participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study using the new International Association of the [...]

Jehovah's Witnesses and their doctors may have to use legal means to resolve the conflict between medicine and religion. The taking of blood into the human body is not permitted by Jehovah's Witness religious doctrines. Doctors of female Jehovah's Witnesses face a unique problem when blood transfusion is necessary. Frequently the patient is pregnant or has living dependent children. The doctor has a moral obligation to respect the woman's rights but also to promote the well-being of those who depend on her. The courts have been inconsistent in their rulings concerning blood transfusions and Jehovah's Witnesses. They have not dealt well with patients who refuse transfusion while competent and then lose consciousness, nor have they routinely upheld written documents refusing transfusion held by unconscious patients. Synthetic blood components, changes in the religious doctrine and more consistent court rulings may make blood transfusion acceptable.

Gestational diabetes mellitus (carbohydrate intolerance), first recognized or beginning during pregnancy, is the most common metabolic disorder of pregnant women. Due to lack of insulin, or its ineffectiveness, the ingestion of glucose and other sugars results in abnormally high blood levels of glucose. It is important to identify women with this disorder because it is associated with significant metabolic alterations leading to increased maternal illnesses such as high blood pressure (hypertension) and higher rates of illness or death at delivery. Long-term complications from gestational diabetes include increased risk of permanent diabetes, obesity, cardiovascular disease, hypertension, and maternal death; the infant also has a higher risk of childhood obesity, diabetes, and mental and physical impairment. A variety of methods have been proposed for screening gestational diabetes. The most recommended single screening method is testing blood glucose levels one hour after the pregnant patient ingests 50 grams of glucose. The blood glucose level that is considered abnormal should be no more than 140 milligrams per deciliter (mg/dl); more cases are detected when the threshold is 130 mg/dl. Due to the high rate of illness and death associated with gestational diabetes, all pregnant women should be screened at least once for the disorder, preferably between 24 and 28 weeks of gestation. Women with glucose levels that exceed the designated threshold should then be given a three hour oral glucose tolerance test to ascertain whether diabetes is indeed present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Percutaneous transluminal angioplasty (PTA) is a procedure for treating narrowing or blockage in blood vessels. It involves inserting a balloon-tip catheter into the constricted vessel and inflating it to open the vessel. It is important to have both an accurate evaluation of the vessel prior to and after the procedure, as this can reveal the extent of the problem in the vessel, residual narrowing in the vessels after the PTA, and success of the PTA. The evaluation of PTA performed in peripheral arteries (that is, those outside the trunk) is normally accomplished by measuring blood flow or pressure beyond the site of the constriction. Duplex ultrasound (US) is an imaging technique that uses high-frequency sound waves. The use of duplex US to image peripheral (outside the trunk) arteries both before and after PTA was evaluated as an alternative method for determining the relative success of the procedure. Twenty-one patients with narrowed or blocked peripheral arteries were examined with duplex US prior to and immediately after PTA, and 25 US image pairs were obtained. PTA was considered successful in 24 of the 25 paired images as determined using traditional measures. Images from the duplex US showed significant residual narrowing in 8 of 24 patients, although clinical results did not indicate such narrowing in six of those same eight patients. The results indicate that duplex US of peripheral arteries is not useful in evaluating the success of PTA when the imaging is performed immediately after PTA is performed. It may be useful for long-term evaluation of the effectiveness of PTA, but further research is needed to evaluate this role. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: Evaluation of acute chest pain is highly variable. Objective: To evaluate the cost-effectiveness of strategies using cardiac markers and noninvasive tests for myocardial ischemia. Design: Cost-effectiveness analysis. Data Sources: Prospective data from 1066 patients with chest pain and from the published literature. Target Population: Patients admitted with acute chest pain. Time Horizon: Lifetime. Perspective: Societal. Interventions: Creatine kinase (CK)-MB mass assay alone; CK-MB mass assay followed by cardiac troponin I assay if the CK-MB value is normal; CK-MB mass assay followed by troponin I assay if the CK-MB value is normal and electrocardiography shows ischemic changes; both CK-MB mass and troponin I assays; and troponin I assay alone. These strategies were evaluated alone or in combination with early exercise testing. Outcome Measures: Lifetime cost, life expectancy (in years), and incremental cost-effectiveness. Results of Base-Case Analysis: For patients 55 to 64 years of age, measurement of CK-MB mass followed by exercise testing in appropriate patients was the most competitive strategy ($43 000 per year of life saved). Measurement of CK-MB mass followed by troponin I measurement had an incremental cost-effectiveness ratio of $47 400 per year of life saved for patients 65 to 74 years of age; it was also the most cost-effective strategy when early exercise testing could not be performed, CK-MB values were normal, and ischemic changes were seen on electrocardiography. Results of Sensitivity Analysis: Results were influenced by age, probability of myocardial infarction, and medical costs. Conclusions: Measurement of CK-MB mass plus early exercise testing is a cost-effective initial strategy for younger patients and those with a low to moderate probability of myocardial infarction. Troponin I measurement can be a cost-effective second test in higher-risk subsets of patients if the CK-MB level is normal and early exercise testing is not an option., Measurement of creatine kinase-MB (CK-MB) levels in blood samples and exercise testing is a cost-effective way of diagnosing heart attack in young patients and people with a low risk of a heart attack. CK-MB is an enzyme that is released into the bloodstream when heart muscle is damaged. Older patients and those at high risk of a heart attack should be tested for elevated blood levels of troponin if their CK-MB level is normal and they cannot participate in exercise testing.

Byline: David A. Sacks, Jeffrey S. Greenspoon Author Affiliation: Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, 9400 E Rosecrans Ave Bellflower, CA 90706 Department of Obstetrics and Gynecology, University of California, Los Angeles-Olive View Medical Center Sylmar, CA 91342 6/8/93239

Yes This randomized, controlled trial of 958 women who had mild gestational diabetes (GDM) found that dietary intervention, self-monitoring of blood glucose, and (when necessary) insulin therapy reduced the risk [...]

The American Diabetes Association (ADA) responds to letters concerning published articles in Diabetes Care. It does not respond to letters concerning presentations at the ADA Annual Scientific Sessions or reports [...]

What's new in healthy living DIABETES 18 NUTRITION 20 EXERCISE 23 WELLNESS 24 IT'S WELL KNOWN that type 1 diabetes stems from an immune system gone awry. Now, a study [...]

An immune response is generated when the body is exposed to foreign substances, or antigens, an event which stimulates the production of protective antibodies. During pregnancy the blood of an infant may not be compatible with that of its mother. Maternal exposure to incompatible fetal blood components can cause the production of antibodies against fetal cells. Although most antigens will not cause the destruction of the fetal blood cells, some antigens can produce antibodies that will can cause serious problems for the fetus. A 29-year-old-woman, pregnant for the fourth time, was found to have a rare antibody to an antigen found in 99.9 percent of the population, the Cromer antigen, which had been detected during her second pregnancy. The mother did not have the Cromer antigen in her blood, nor did one of her living children. The antigen-negative blood was stored and frozen in the event a blood transfusion was indicated. The next two pregnancies were monitored carefully and both fetuses, who both had the antigen, were unaffected.