Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital.

We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ≥0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ≥0·92 g/l and/or ≥1·80 g/l after 1 hour and/or ≥1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ≥90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.

[Intravenous administration of ritodrine to pregnant insulin-dependent diabetics. Metabolic impact]. / Administration intraveineuse de ritodrine chez la diabétique insulino-dépendante enceinte. Répercussions métaboliques.

Seven diabetic patients who had been dependent on insulin before pregnancy (classes B, C, D of White) threatened to go into premature labour between the 31st and 36th week of the pregnancy. They were treated by intravenous administration of Ritodrine, the dosage varying between 100 and 400 micrograms per minute. The changes in the mother consisted in a rise in the blood glucose level which rose from 140 +/- 34 mg % to 212 +/- 56 mg % (p less than 0.01). This occurred in spite of a mean rise of 49% of insulin (p less than 0.0025) and a moderate ketonuria in two patients and a severe acido-ketosis in two further patients. In five patients there were no effects on the fetus as far as repeated observations of the fetal heart rate could detect. On the other hand, in the two mothers who developed acido-ketosis during the transfusion the fetal heart rythm showed signs of acute fetal distress, which however was temporary. Oscillations were reduced and there were late decelerations. These disappeared when the maternal metabolic state was brought back to equilibrium. 13.1 +/- 7.3 days were gained for the fetus by using tocolytic treatment, and this is considered a success. Discussion of these cases is accompanied by a complete review of the literature of the administration of beta-mimetic drugs in diabetic women. The authors point out that special precautions have to be taken and special conditions have to be fulfilled when this type of treatment is used. These consist of changes in the amounts of insulin that are given and particularly careful observation of the fetal heart rhythm before and during treatment.