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A representative sample of 817 American women aged 20-44 yr who were not pregnant and had no medical history of diabetes were given 75-g 2-h oral glucose tolerance tests (OGTTs). Although these conditions are somewhat different from those recommended for pregnant women (100 g glucose, 3-h OGTT), 3.8% of the women might have been considered to have met O'Sullivan and Mahan criteria for gestational diabetes mellitus (GDM) had they been pregnant. Prevalence was 2-3% below age 35 yr, similar to that found in studies of pregnant women, and rose to 8% at age 40-44 yr. Rates of women meeting World Health Organization criteria for gestational impaired glucose tolerance (G-IGT) rose steadily from 5% at age 20-24 yr to 11% at age 40-44 yr. Risk factors for non-insulin-dependent diabetes mellitus (NIDDM) including parental history and obesity were more prevalent among women meeting these criteria than among women in the entire group; the same risk factors are also more prevalent among pregnant women with GDM. The similarity of rates in this study to rates of GDM and G-IGT, together with their association with risk factors for NIDDM, indicate that these entities are compatible with undiagnosed glucose intolerance occurring before pregnancy and discovered during the metabolic testing that generally accompanies prenatal care rather than conditions that have an etiologic relationship to pregnancy.
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PMID:Gestational diabetes may represent discovery of preexisting glucose intolerance. 339 Oct 90

Four hundred and forty-seven women who had gestational diabetes have been retested at intervals from 1 to 12 years following diagnosis; 49 (11%) were found to be diabetic and 35 (7.8%) had impaired glucose tolerance using the WHO criteria. An abnormal glucose tolerance test in the puerperium and obesity at the time of retesting had significant associations with abnormal glucose tolerance at follow-up. However, the best predictive factor of the likelihood of the development of significant hyperglycaemia was the recurrence of gestational diabetes in a subsequent pregnancy, since 28% of these women were diabetic and a further 4% had impaired glucose tolerance at the time of follow-up. These findings indicate that the criteria used for the diagnosis of gestational diabetes at the Mercy Maternity Hospital, Melbourne (1-hour greater than or equal to 9 mmol/l together with a 2-hour greater than or equal to 7 mmol/l) are appropriate for an Australian population.
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PMID:The long-term follow-up of women with gestational diabetes. 346 May 70

The Second International Workshop-Conference on Gestational Diabetes was held in Chicago, IL on October 25-27, 1984 as an invitational meeting sponsored by the American Diabetes Association with the cooperation of the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Diabetic Pregnancy Study Group of the European Association for the Study of Diabetes. The meeting was convened to collate existing information about gestational diabetes mellitus and to use state-of-the-art appraisals to achieve consensus about definitions, prognoses, and strategies for success, diagnosis, and intervention. The invited presentations documented that gestational diabetes mellitus is a heterogeneous disorder with varying incidence in various parts of the world. The increased obstetric and perinatal risk of undetected gestational diabetes was supported. The reports clearly established that more than half of the women with gestational diabetes mellitus ultimately develop permanent diabetes. Mounting evidence also suggests the possibility of long-range complications such as increased obesity and diabetes in the offspring. The available experiences with a variety of therapies such as diet and insulin were reviewed. The meeting highlighted the importance of gestational diabetes mellitus as a distinct entity deserving of increased recognition, treatment, long-range follow-up, and research.
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PMID:Definition, detection, and management of gestational diabetes. 351 12

The nomenclature of human diabetes mellitus (DM) has been revised, and this classification has been accepted throughout the medical world and literature. The major categories of diabetes are: insulin-dependent DM, type I or IDDM; noninsulin-dependent DM, type II or NIDDM; secondary DM or type S; impaired glucose tolerance, IGT; gestational diabetes; and previous abnormality of glucose tolerance, PrevAGT. A review of the literature has shown that over half of the documented diabetic dogs, with a single medical diagnosis, appear to be type I, IDDM, with a substantial proportion being type S, and the remainder being type II, NIDDM. Obesity is frequently associated with IGT and NIDDM. Diabetic cats most commonly have pancreatic islet destruction associated with pancreatic amyloidosis; they are insulin deficient, IDDM. The commonest causes of secondary diabetes in dogs are pancreatic damage, hyperadrenocorticism and hypersomatotropism secondary to persistent progesterone influence. Progestogen therapy is the most frequently reported cause of secondary diabetes in cats. Diabetes in horses is type S, usually secondary to a functional pituitary tumor but occasionally following chronic pancreatitis. The blood glucose ranges for normal, IGT and diabetic animals, and the normal serum insulin values of various species is tabulated.
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PMID:Definition of diabetes mellitus. 351 69

The biological significance of ketonemia of brief duration and moderate proportions during pregnancy remains uncertain. Thus, controversy persists about whether caloric restriction for obese women during pregnancy, particularly when the obesity is complicated by gestational diabetes mellitus (GDM), constitutes appropriate therapy. We have demonstrated, in a rigorously controlled setting using a Clinical Research Center, that all of the features of 'accelerated starvation' become manifest after 14 h and before 18 h of dietary deprivation. Women with GDM exhibit the same capacity for early 'accelerated starvation' as in normal pregnancy; thus, their insulin deficiency and insulin resistance do not appear to be sufficient to render them increasedly at risk for uncontrolled catabolism. Some cautious exploration of the use of hypocaloric diets as a therapeutic approach to the metabolic disturbances of GDM may be justified.
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PMID:Accelerated starvation in pregnancy: implications for dietary treatment of obesity and gestational diabetes mellitus. 355 61

We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor.
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PMID:Maternal obesity and pregnancy. 357 19

In 69 patients with a gestational diabetes-diagnosed by reproducible pathological results of two oral glucose loads (50 g) or by fasting blood glucose values of greater than or equal to 6.7 mmol/l in pregnancy the carbohydrate metabolism was checked postgestationally again with a glucose tolerance test (75 g) in a period of 6 weeks up to 2 years post partum. The postgestational classification showed the following results: manifested diabetes n = 15 (21.7%), impaired glucose tolerance n = 15 (21.7%), non-classificable disturbed carbohydrate tolerance n = 10 (14.5%), normal test results n = 29 (42%). The high rate of diabetic manifestations underlines the necessity of a postgestational classification of the so-called gestational diabetes controlled by the delivering center. The high risk of manifestation is calculable in the whole group, but not predictable for the single case. The risk is the higher the earlier a glucosuria in pregnancy can be found (before the 24th week), the earlier an insulinisation is necessary to guarantee a normoglycemia and the higher individual deviations of the individual blood glucose values during the daily course are observed (measurable with the glycemic index acc. Michaelis et al.). Additional risk factors are: obesity, an age over 30 years at the beginning of pregnancy, and heredity of first degree. From the retrospective point of view of a postgestational classification new therapeutic aspects could not be verified to avoid diabetes manifestation. Nevertheless an exact normoglycemic control and a very early start of treatment, a correct screening of risk factors and an immediate diagnosis of a gestational diabetes are a supposition to avert hyperglycemic dangers from the child.
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PMID:[The fate of patients with diabetes in pregnancy--classification of gestational diabetes following the completion of pregnancy (p.g. classification)]. 357 70

A one-year experience of screening for gestational diabetes is reported. Patients with any of seven risk factors were screened at the time of prenatal registration. Those without risk factors, and those not found to be diabetic by 24 weeks' gestation, were tested later in pregnancy. Of 4116 patients, 77% had at least one risk factor. The prevalence of diabetes in patients with risk factors was significantly greater than among those with no risk factors (P less than .001). Of 936 patients who had no risk factors, four were found to have diabetes. Multiple logistic regression analysis suggested that family history, obesity, and age over 25 years contributed significantly to the prediction of gestational diabetes. More than 10% of gestational diabetics had screening values between 135-139 mg/dL. Among patients whose early screening values were elevated and whose initial glucose tolerance tests were normal, the odds of being classified ultimately as a gestational diabetic were 7.3 times that of patients whose initial screening tests were normal. Selective screening based on risk factors including maternal age may enhance detection of diabetes early in gestation.
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PMID:Screening for gestational diabetes with the one-hour 50-g glucose test. 360 Dec 72

Since macrosomic infants of diabetic mothers tend to remain obese throughout their lives, and obesity and heredity are factors predisposing to Type II diabetes, it can be hypothesized that infants who are going to develop diabetes later in life are more likely to be macrosomic at birth than those who are not going to develop diabetes as adults. This hypothesis was tested, using the c57/KsJdb+/+m mouse animal model of gestational diabetes. This animal is frankly diabetic in the homozygous diabetic form. In the heterozygous form, it develops gestational diabetes, and in the homozygous normal form, it is normal. The pups of heterozygous males and females that were bred were weighed, classified by sex, and identified. At 4 weeks of age, the genetic makeup of the pups was determined. From 37 litters, 140 pups were born and raised to weaning age. Multiple regression analysis of the data revealed that the homozygous diabetic pups weighed most at birth; the heterozygous gestationally diabetic pups weighed less, and the homozygous normal pups weighed the least. All comparisons of these groups were statistically significant. Sex and interlitter variation also were found to be significant factors determining birthweight. Controlling for sex and interlitter variation did not change the significance of the effect of the genetic tendency for diabetes on birthweight. This study indicates that in Type II diabetes, neonatal macrosomia in part may be determined by the genetic or congenital susceptibility to develop diabetes in the future.
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PMID:Diabetic pregnancy. The effect of genetic susceptibility for diabetes on fetal weight. 379 Feb 19

Of 2276 patients who underwent screening for gestational diabetes mellitus, 1854 (81.5%) had normal glucose screening tests after a 50-g carbohydrate load (serum glucose below 135 mg/dL). Three hundred fifty-seven patients (15.7%) had abnormal glucose screening tests and went on to complete three-hour glucose tolerance tests, of whom 176 (48.7%) were shown to be nondiabetic when further tested using a carbohydrate-loaded, 100-g glucose, three-hour glucose tolerance test. The 176 women with abnormal glucose screens but normal glucose tolerance tests were compared with the 1854 who had normal screening values. The frequency of infants weighing more than 4000 g (greater than 95th percentile at our institution) was 11.9% in the study group and 6.4% in the control group (P = .0086). When the data were corrected for other macrosomia risk factors (advanced age, high parity, obesity, white race, and prolonged gestation), there was still a significantly higher frequency of macrosomia in the study group; this fact suggests that patients with minor abnormalities of carbohydrate metabolism during pregnancy are at risk for delivering a macrosomic infant.
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PMID:Abnormal glucose screening tests in pregnancy: a risk factor for fetal macrosomia. 382 98


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