A Comparison of Predictive Performances between Old versus New Criteria in a Risk-Based Screening Strategy for Gestational Diabetes Mellitus

Background@#The definition of the high-risk group for gestational diabetes mellitus (GDM) defined by the American College of Obstetricians and Gynecologists was changed from the criteria composed of five historic/demographic factors (old criteria) to the criteria consisting of 11 factors (new criteria) in 2017. To compare the predictive performances between these two sets of criteria. @*Methods@#This is a secondary analysis of a large prospective cohort study of non-diabetic Korean women with singleton pregnancies designed to examine the risk of GDM in women with nonalcoholic fatty liver disease. Maternal fasting blood was taken at 10 to 14 weeks of gestation and measured for glucose and lipid parameters. GDM was diagnosed by the two-step approach. @*Results@#Among 820 women, 42 (5.1%) were diagnosed with GDM. Using the old criteria, 29.8% (n=244) of women would have been identified as high risk versus 16.0% (n=131) using the new criteria. Of the 42 women who developed GDM, 45.2% (n=19) would have been mislabeled as not high risk by the old criteria versus 50.0% (n=21) using the new criteria (1-sensitivity, 45.2% vs. 50.0%, P>0.05). Among the 778 patients who did not develop GDM, 28.4% (n=221) would have been identified as high risk using the old criteria versus 14.1% (n=110) using the new criteria (1-specificity, 28.4% vs. 14.1%, P<0.001). @*Conclusion@#Compared with the old criteria, use of the new criteria would have decreased the number of patients identified as high risk and thus requiring early GDM screening by half (from 244 [29.8%] to 131 [16.0%]).

Considerations regarding medical services for undocumented migrant workers

The number of undocumented migrant workers in Korea is increasing. They are not covered by national health insurance, and thus find it difficult to access medical services. A number of medical service teams from religious organizations and some hospitals provide targeted services to migrant workers through special programs, but they face many limitations of scope and resources. In a globalized world, undocumented migrant workers should not be treated as simply passing through. Health care for these guests to our country should be of the quality we would expect for our neighbors and families.

Maternal and Perinatal Outcomes in Pregnancies Complicated with Placenta Previa Totalis / 대한주산의학회잡지

OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.

Comparison of Pregnancy Outcome between Low Dose Aspirin Alone and Aspirin Plus Prednisolone Treatment in Recurrent Spontaneous Abortion Associated with Antiphospholipid Antibodies / 대한산부인과학회잡지

We performed this study to compared pregnancy outcome between low dose aspirin alone and aspirin plus prednisolone treatment in patient of recurrent spontaneous abortion associated with antiphospholipid antibodies. From May 1994 to March 1996, forty-two patients of recurrent spontaneous abortion associated with antiphospholipid antibodies were randomized to receive either low dose aspirin alone(LDA group, n=21) or aspirin plus prednisolone(AP group, n= 21). When pregnancy was confirmed, women were stared with 100mg of aspirin oral daily until 29 weeks of gestation and thereafter 50 mg daily until 35 weeks of gestation in LDA group. In AP group, aspirin administration was same as LDA group and prednisolone was administrated 30 mg oral daily until 24 weeks of gestation and thereafter 10 mg daily until 35 weeks of gestation. Lupus anticoagulant(LAC) was positive in 15 patients, anticardiolipin antibody (ACL) was positive in 24 patients, and both were positive in 3 patients. There was not significant difference in the rate of spontaneous abortion between LDA and AP group[7/21(33.3%) vs 3.21(14.3%)]. There was also no significant difference in live birth rate between LDA and AP groups[14/21(66.7%) vs 18/21(85.7%)]. In LAC positive patients, there was lower rate of live birth in LDA group than in AP group, but not significantly different[4/8(50.0%) vs 6/7(85.7 %)]. In ACL positive patients, there was no significant difference in live birth rate between LDA and AP groups[10/12(83.3%) vs 11/12(91.7%)]. In the case of both LAC and ACL positive patients, there was also no significant difference in live birth rate between LDA and AP group [0/1(0.0%) vs 1/2(50.0%)]. There were no significant difference in mean gestational age and mean fetal body weight at delivery between LDA and AP groups(35.5+/-3.0 vs 36.7+/-2.5 wks, 2546.0+/-685.9 vs 2693.3+/-683.6 gm). There were also no significant difference in the rate of cesarean section due to fetal distress, the rate of Apgar score less than 7 at 5 minutes, the rate of admission to neonatal intensive care unit, and the rate of perinatal mortality between two groups. There was no congenital anomalous fetuses in all study patients. We found that combined treatment of aspirin plus predinisolone might be potentially more effective than low dose aspirin alone in patients of recurrent spontaneous abortion associated with antiphospholipid antibodies, especially in patients of LAC positive.