Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta-analysis.

The Institute of Medicine updated guidelines for gestational weight gain in 2009, with no special recommendations for gestational diabetes. Our objectives were to describe the prevalence of weight gain adequacy and their association with adverse pregnancy outcomes in gestational diabetes. We searched MEDLINE, EMBASE, COCHRANE and SCOPUS. We calculated the pooled prevalence of gain adequacy and relative risks for pregnancy outcomes within Institute of Medicine categories. Thirty-three studies/abstracts (88,599 women) were included. Thirty-one studies provided data on the prevalence of weight gain adequacy; it was adequate in 34% (95% CI: 29-39%) of women, insufficient in 30% (95% CI: 27-34%) and excessive in 37% (95% CI: 33-41%). Excessive gain was associated with increased risks of pharmacological treatment, hypertensive disorders of pregnancy, caesarean section, large for gestational age and macrosomic babies, compared to adequate or non-excessive gain. Weight gain below the guidance had a protective effect on large babies (RR: 0.71; 95% CI: 0.56-0.90) and macrosomia (RR 0.57; 95% CI 0.40-0.83), and did not increase the risk of small babies (RR 1.40; 95% CI 0.86-2.27). Less than recommended weight gain would be beneficial, while effective prevention of excessive gain is of utmost importance, in gestational diabetes pregnancies. Nevertheless, no ideal range for weight gain could be established.

Lipid accumulation product index: a reliable marker of cardiovascular risk in polycystic ovary syndrome.

BACKGROUND: Metabolic disturbances are common features of polycystic ovary syndrome (PCOS), which possibly enhance the risk of cardiovascular disease. The aim of this study was to assess the accuracy of lipid accumulation product (LAP) index as a marker of cardiovascular risk in PCOS patients. METHODS: Case-control study including 51 PCOS patients aged between 14 and 35 years and 44 body mass index (BMI) and age-matched controls. Measures included the LAP index, homeostasis model assessment (HOMA) index, glucose tolerance and plasma hormones, cholesterols and triglycerides. RESULTS: LAP index was positively correlated with HOMA index in all subjects (r = 0.70; P < 0.001). Waist circumference (WC) (P = 0.002), HOMA index (P < 0.001) and LAP index (P = 0.035) were higher in PCOS patients than controls. On receiver operating characteristic curve analysis, an LAP index of 34.5 (sensitivity: 84%; specificity 79%) showed a better performance than non-high-density lipoprotein cholesterol, WC or BMI to identify insulin resistance (IR) in all subjects. In PCOS patients, the positive and negative predictive values for LAP > or = 34.5 were 91 and 74%, respectively, compared with 73 and 61%, respectively, for WC > or =80 cm, and 43 and 20%, respectively, for WC > or =88 cm. CONCLUSIONS We have confirmed that IR is more common in PCOS than BMI-matched control women. Furthermore, the LAP index, an easily obtainable measure, is associated with HOMA index and an LAP > or = 34.5 is an additional risk factor for cardiovascular disease in PCOS patients.