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Query: UMLS:C0011849 (diabetes)
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Although gestational diabetes is estimated to complicate between 1% and 5% of pregnancies, there are only limited data on the role of race/ethnicity as well as other risk factors in the development of this disorder. Epidemiologic characteristics of gestational diabetes were assessed in an ethnically diverse cohort of 10,187 women who had undergone standardized screening for glucose intolerance and who delivered a singleton infant at the Mount Sinai Medical Center in New York City between January 1987 and December 1989. The overall prevalence of gestational diabetes was 3.2%. Multiple logistic regression analysis showed excess risks for Oriental women, Hispanics born in Puerto Rico or elsewhere outside the United States, women from the Indian subcontinent and the Middle East, older mothers, heavier women, those with a positive family history of diabetes, women with a history of infertility, and those who delivered on the clinic service. These data suggest that, after controlling for traditional risk factors (maternal age, prepregnancy weight, and a family history of diabetes), Orientals, first generation Hispanics, women from the Indian subcontinent and the Middle East, those with a history of infertility, and low socioeconomic status women are at an increased risk for gestational diabetes.
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PMID:Race/ethnicity and other risk factors for gestational diabetes. 846 11

The pathogenesis of plasma membrane alterations present in diabetes mellitus is unclear. To add new insights to the question, platelet membrane properties were evaluated in 16 women presenting impaired glucose tolerance at the 28-29th week of gestation (GDM) and in 8 women with insulin-dependent diabetes mellitus (IDDM). 15 healthy pregnant women (HPW) and 21 healthy non-pregnant (HNPW) women were the control group for GDM and IDDM, respectively. Pregnancy (HPW vs. HNPW) provoked an increase in Ca(2+)-ATPase activity and a decrease in membrane fluidity; in contrast, Na+/K(+)-ATPase, intracellular free Ca2+ concentrations, membrane cholesterol and phospholipid content did not vary. Both GDM and IDDM showed lower Na+/K(+)-ATPase activity and higher Ca2+ concentration, compared to HPW and HNPW, respectively, whereas Ca(2+)-ATPase activity was higher only in IDDM; furthermore, membrane fluidity was lower in GDM and higher in IDDM. Finally, GDM showed higher membrane cholesterol content. Both GDM and IDDM showed a very good metabolic control so that variations reported cannot be due to hyperglycemia; it is tempting to suggest that membrane variations are present before the clinical metabolic alteration. Furthermore, both GDM and IDDM were on insulin therapy, therefore: (i) insulin may be the pathogenetic factor of higher intracellular free Ca2+ concentrations and lower Na+/K(+)-ATPase activity since they both varied accordingly in GDM and IDDM, but not of (ii) changes in Ca(2+)-ATPase, membrane fluidity and cholesterol content which did not vary accordingly in GDM and IDDM.
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PMID:Modifications in platelet membrane transport functions in insulin-dependent diabetes mellitus and in gestational diabetes. 161 Sep 20

Caloric restriction during pregnancy is contraindicated for women with a normal body mass index (BMI) of 19.8-26 kg/m2. Reduction of caloric intake in obese pregnant normal and diabetic women has been a controversial topic for many years. This paper reviews several clinical studies initiated in 1978 at the University of California, San Diego. One focus of this review concerns modest caloric reduction in obese women with gestational diabetes mellitus (GDM). Metabolic observations of diabetes during pregnancy in the past decade include extensive use of a 400 kcal isocaloric breakfast meal tolerance test to assess maternal glucose:insulin relationships and the degree of insulin resistance in obese pregnant subjects. We have previously reported that maternal hyperinsulinemia with or without maternal hyperglycemia is an important factor in fetal macrosomia. We suggest for obese pregnant diabetic women implementation of nutritional recommendations of the 1990 Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences that advise a lower caloric intake for obese normal pregnant women with BMIs greater than 26. In obese noninsulin-dependent diabetic women and those with GDM, we urge that a large prospective epidemiologic study be undertaken to assess the respective roles of modest maternal caloric restriction and maternal glucose:insulin relationships on neonatal and long-term longitudinal measurements of growth and development of children of diabetic mothers.
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PMID:Caloric restriction in pregnant diabetic women: a review of maternal obesity, glucose and insulin relationships as investigated at the University of California, San Diego. 161 75

Variations in nutritional intake during pregnancy have measurable effects on the circulating levels of maternal nutrients, maternal weight gain, and birth weight of the offspring. A growing body of evidence indicates that alterations in maternal metabolism can also have long-term consequences in the offspring in relation to adult adiposity, glucose tolerance, and perhaps intellectual development. Therefore, recommendations for diet during pregnancy must be made with great care, and with as much scientific understanding as possible. Nutritional advice traditionally given to all pregnant women, including those with gestational diabetes mellitus (GDM) or noninsulin-dependent diabetes, does not allow for individual differences in caloric needs as a function of the degree of maternal obesity and thus, may encourage excessive weight gain. Evidence reviewed below suggests that adjusting caloric intake to meet new guidelines for weight gain during pregnancy may be advantageous in reducing maternal blood sugar and insulin levels, without producing abnormalities in other metabolic variables. Modest caloric reduction which limits excessive weight gain in the mother may also be associated with a small reduction of fetal weight. However, more stringent dietary manipulations in obese gravida should be discouraged as a routine measure until more knowledge is available from large-scale clinical trials about their effects on the entire panoply of maternal nutrients and their impact on the offspring.
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PMID:Caloric restriction in gestational diabetes mellitus: when and how much? 161 76

Alterations in erythrocyte plasma membrane properties (enzymatic activities and membrane fluidity) have been observed in patients affected by insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). In order to verify whether these alterations are present also in gestational diabetes mellitus (GDM) we studied the plasma membranes obtained from two different cellular types (erythrocyte from both mother and cord blood and placenta syncytiothrophoblast cell) of 16 healthy pregnant women and 15 women affected by GDM. The following determinations were performed on the membrane preparations: Na+/K(+)-ATPase activity, acetyl-cholinesterase (AchE) activity, membrane fluidity and cholesterol:phospholipid ratio. We observed a reduction of both enzymatic activities and a decrease of membrane fluidity in maternal and cord blood erythrocytes and in syncytiotrophoblast plasma membranes in GDM pregnant women in comparison with controls. The cholesterol to phospholipid ratio was significantly lower in the erythrocyte membranes of women affected by GDM than in normal pregnant women, while it was increased in the cord blood erythrocyte membranes and in placental membranes in GDM in comparison with controls. The present study found, in GDM patients, a membrane alteration similar to the abnormality reported in IDDM and NIDDM (i.e. decreased Na+/K(+)-ATPase activity), while opposite modifications were observed with regard to other membrane activities and properties. The different membrane alterations observed in GDM with respect to IDDM and NIDDM might be linked to the different degree of metabolic control, on the contrary the reduced Na+/K(+)-ATPase activity might be a primary event in the pathogenesis of diabetes mellitus per se and might constitute a signal of high risk of developing the disease later in the women affected by GDM during pregnancy.
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PMID:Modifications induced by gestational diabetes mellitus on cellular membrane properties. 165 18

Fructosamine, glycosylated hemoglobin (HbA1c) and serum total proteins were measured in normal nondiabetic pregnant women (n = 170) at three stages of pregnancy (14-18, 24-28, and 32-40 weeks of gestation). No significant correlation was found between fructosamine and either HbA1c or total plasma proteins. Only early in pregnancy (less than 20 weeks of gestation) was a correlation found between fructosamine and fasting blood glucose (r = 0.40, P less than 0.05). There was also no correlation between either tests (i.e. fructosamine and HbA1c) and fetal birthweight. The value of fructosamine measurement in the detection of diabetes in pregnancy was further tested in a group of high-risk patients (n = 98) for developing carbohydrate intolerance. It is concluded that fructosamine has limited value as a screening test for gestational diabetes mellitus, particularly for the mild form of the glucose intolerance.
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PMID:Fructosamine as a screening-test for gestational diabetes mellitus: a reappraisal. 167 Oct 17

We analyzed 215 consecutive patients with diabetes mellitus and pregnancy, 118 (54.83%) with noninsulin dependent diabetes mellitus (NIDDM), 90 (41.86%) with gestational diabetes mellitus (GDM) and 7 (3.26%) with insulin dependent diabetes mellitus (IDDM). NIDDM and GDM patients had no significant difference in age and body mass index. There were no maternal deaths, nor episodes of ketoacidosis. Maternal and neonatal complications occurred with a similar frequency in NIDDM and GDM. We concluded that in our population, diabetes associated with insulin-resistance occurred in over 96% of our pregnant diabetic patients and was associated with an increased prevalence of maternal and neonatal complications. Earlier perinatal care has to be established in NIDDM patients, and obese young women should be screened to detect GDM from early gestation and advised to reduce weight before pregnancy ensues.
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PMID:Noninsulin dependent diabetes mellitus and pregnancy in Mexico. 167 35

Of the contraceptive choices open to a post-partum woman with gestational diabetes, this discussion concentrates on low-dose oral contraceptives. Although gestational diabetes usually clears at delivery, 75% of these women will go on to developed impaired glucose tolerance or overt diabetes, especially if they are obese or if their glucose level had been high. Many elect permanent sterilization, but those requiring reversible contraception usually choose the IUD or the pill. IUDs carry a high risk of infection and are less effective in diabetics. The author compared a low-dose combined pill with 400 mcg norethindrone and 35 mcg ethinyl estradiol (Ovcon 35), and a pill containing levonorgestrel (Triphasil), to barrier contraception in 230 women with recent gestational diabetes. After 6-13 months of use 11-17% of each group had impaired glucose tolerance, and 15-20% of each group had diabetes (n.s.). Insulin levels rose from 28.5 mIU/mL to 59.7 in controls, 32.0 to 71.8 in Ovcon 35 users, and from 40.2 to 85.1 in Triphasil users (p0.05). HDL values rose significantly in the group taking Ovcon, and LDL values fell significantly in all 3 groups. These low-dose pills can be used safely in postpartum gestational diabetic women, as long as they do not smoke, are encouraged to lose weight, and have no sign of cardiovascular disease as evidenced by albuminuria and an ophthalmoscopic exam.
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PMID:Contraceptive options for the gestational diabetic woman. 167 21

Hair chromium concentration (HCC) of normal and diabetic pregnant women was determined by atomic-absorption spectroscopy. For nondiabetic pregnant women the value from 68 hair samples was 472 +/- 61 ng/g (mean +/- 95% CI); for gestational diabetics it was 734 +/- 155 ng/g from 42 hair samples. The difference was highly significant (P less than 0.005). Intermediate hair chromium concentrations were observed in 20 pregnant women with pregestational, overt diabetes mellitus (mean: 575 +/- 182 ng/g). Fifty-two women had a second hair sample taken later during pregnancy that showed a significant decrease in HCC (P less than 0.05). However, this decrease was confirmed only for the diabetic pregnant group. Age and parity did not influence the HCC. The data suggest that impaired utilization of chromium may be a possible etiology for gestational diabetes mellitus.
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PMID:Hair chromium content of women with gestational diabetes compared with nondiabetic pregnant women. 172 9

We studied the long-term effects of maternal diabetes mellitus on the offspring of experimentally induced diabetic Wistar rats. When stressed by an intravenous glucose load, the adult female offspring had impaired glucose tolerance and developed gestational diabetes mellitus when pregnant. Our results show that even mild diabetes mellitus induces an abnormal intrauterine milieu that causes morphological and functional changes in fetal development with consequences for later life.
Diabetes 1991 Dec
PMID:Metabolic alterations in adulthood after intrauterine development in mothers with mild diabetes. 174 38


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