Adverse Pregnancy Outcomes Using The International Association of the Diabetes and Pregnancy Study Groups Criteria: Glycemic Thresholds and Associated Risks.

OBJECTIVE: To compare the risks of selected adverse pregnancy outcomes among untreated women who met The International Association of the Diabetes and Pregnancy Study Groups (IADPSG)-defined glucose criteria at two different thresholds. METHODS: A retrospective cohort study of women tested for gestational diabetes mellitus (GDM) with the 75-g 2-hour glucose tolerance test (GTT) who delivered a live singleton neonate. Data of women who were treated because they met institutional criteria defining GDM (at least two GTT results greater than or equal to fasting 100 mg/dL, 1-hour 195 mg/dL, and 2-hour 160 mg/dL) were excluded. The data of the remaining women were analyzed in three groups. The prevalence of selected adverse pregnancy outcomes was compared for those with no GDM ("no GDM," n=7,943); those at least one of whose results were fasting 92-94 mg/dL, 1-hour 180-190 mg/dL, or 2-hour 153-161 mg/dL ("GDM-1," n=771); and those at least one of whose results were greater than or equal to fasting 95 mg/dL, 1-hour 191 mg/dL, or 2-hour 162 mg/dL ("GDM-2," n=1,121). RESULTS: Of the 9,835 women, 1,892 (19.2%) met criteria for GDM, of whom 771 (40.8%) were categorized as GDM-1 and 1,121 (59.2%) GDM-2. After adjustment for confounders, women with GDM-2 were at significantly greater risk for preeclampsia or eclampsia, preterm delivery, primary cesarean delivery, shoulder dystocia, higher birth weight, ponderal index, large for gestational age, transient tachypnea, and neonatal hypoglycemia than women without GDM. Only birth weight and large for gestational age were significantly greater in the GDM-1 compared with the no GDM group. CONCLUSION: Fewer adverse outcomes are found at lower levels of the IADPSG-defined glucose intolerance spectrum. Determining whether these patients will benefit from treatment will require a randomized controlled trial. LEVEL OF EVIDENCE: II.

Alteration of endothelial function markers in women with gestational diabetes and their fetuses.

OBJECTIVE: We tested the hypothesis that women with gestational diabetes mellitus (GDM) and their fetuses would demonstrate alterations in markers of endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and endothelial dysfunction and these changes would correlate with the levels of hyperglycemia through a pilot observational case-control study of women with GDM and their fetuses. METHODS: Levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), C-reactive protein (CRP), nitric oxide (NO), eNOS, p22-phox, and SOD gene expression, and endothelial progenitor cells (EPC) counts in both maternal and cord blood were measured at the time of delivery in women with and without GDM. RESULTS: We demonstrated the presence of decreased maternal circulating EPC counts, increased soluble adhesion molecules in maternal blood, decreased SOD expression in both maternal and cord blood and increased eNOS expression in both maternal and cord blood in women with GDM. CONCLUSIONS: These data suggest that the molecular mechanisms behind oxidative stress in women with GDM and their fetuses appear similar to those hypothesized for non-pregnant adults with type 2 diabetes mellitus (DM).

Effect of thyroid peroxidase antibodies on thyroid-stimulating hormone reference limits in a primarily Latina population.

The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and assess its effect on the thyroid-stimulating hormone (TSH) reference range during pregnancy in a primarily Latina population. Serum samples were collected from healthy pregnant women and non-pregnant controls. TSH reference ranges were calculated when TPOAb-positive patients were either included or excluded. A total of 134 pregnant women and 107 non-pregnant controls were recruited. Positive TPOAb titres were found in 23 (17.2%) of the 134 pregnant women, and in 14 (13.1%) of the 107 non-pregnant controls. When the TPOAb-positive women were included in the TSH analysis, the upper reference limit using two different methods was consistently higher: 0-2.2 fold in the non-pregnant women, 2.01-2.78 fold in the first trimester, 3.18-4.7 fold in the second and 1.05-1.42 fold in the third. The lower TSH reference limit was not affected by the inclusion of TPOAb-positive subjects. In conclusion, inclusion of TPOAb-positive patients results in higher upper reference limits during pregnancy.

Insulin resistance and preeclampsia in gestational diabetes mellitus.

OBJECTIVE: To compare the degree of insulin resistance in women with gestational diabetes mellitus (GDM) who do and do not develop preeclampsia. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study of initially normotensive women with GDM who underwent oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and glucose clamp studies in the early third trimester (n = 150) and 15 months postpartum (n = 89). After delivery, the women were categorized as nonpreeclamptic or preeclamptic (systolic blood pressure [SBP] > or = 140 mmHg, diastolic blood pressure [DBP] > or = 90 mmHg, and at least >1+ proteinuria or >300 mg/24 h). Metabolic parameters between the groups were compared by chi2 or Fisher's exact tests and ANOVA with P < 0.05 as significant. RESULTS: A total of 29 women (19%) developed preeclampsia, which was mild in 21 and severe in 8 women. At entry, there were no differences in age, weight indexes, and glycemic measures between the nonpreeclamptic and preeclamptic groups. Those with preeclampsia were significantly taller (61.5 +/- 2.4 vs. 60.1 +/- 2.3 in, P = 0.003), were more often nulliparous (38 vs. 16%, P = 0.01), and had higher entry SBP (112 +/- 10 vs. 103 +/- 6.9 mmHg, P < 0.0001) and DBP (64 +/- 9 vs. 59 +/- 5 mmHg, P = 0.002). No significant differences between the groups were found in any measures of the OGTT glucose levels, insulin sensitivity index, glucose effectiveness, acute response to glucose, or disposition index, nor were there any differences found in the euglycemic clamp measures of basal or steady-state levels of glucose, insulin, free fatty acid, hepatic glucose output, peripheral glucose clearance, C-peptide, or glucagon. At 15 months postpartum, blood pressure levels remained significantly higher in the preeclamptic group (n = 19) compared with the nonpreeclamptic group (n = 70). No differences in any glycemic or insulin resistance measures were found. CONCLUSIONS: Women with GDM were uniformly insulin resistant. Those who developed preeclampsia, when compared with those who remained nonpreeclamptic, were not more insulin resistant in either the third trimester or 15 months postpartum. However, women who developed preeclampsia had blood pressure levels that were significantly higher, although still in the normal range, than those of women who remained nonpreeclamptic.