Is postnatal oral glucose tolerance testing necessary in all women with gestational diabetes.

Currently, women with gestational diabetes mellitus have a repeat oral glucose tolerance test 6 weeks after delivery to identify those with persistent glucose intolerance. In this study, 298 women with gestational diabetes had a postnatal oral glucose tolerance test and of these, 23.2% had persistent glucose intolerance after delivery. The aim of this study was to determine if the antenatal oral glucose tolerance test results could be used to predict which patients would have persistent glucose intolerance after delivery. If only those with severely abnormal antenatal results had persistent disease, then those with only mildly abnormal antenatal results could be spared the postnatal oral glucose tolerance test. Using receiver operator characteristic curves, this study showed that the antenatal oral glucose tolerance test results could not be used to predict reliably which patients would continue to have abnormal glucose tolerance postnatally. Hence, postnatal oral glucose tolerance testing of all patients with gestational diabetes is still necessary as the detection of persistent glucose intolerance is important for the control of the diabetic condition so as to minimise long-term complications.

Using glucose tolerance test results to predict insulin requirement in women with gestational diabetes.

This study was done to test the clinical impression that the result of the oral glucose tolerance test could be used to predict which patients with gestational diabetes did not need insulin therapy. If this was true, a full blood sugar profile assessment could be avoided in many of these women. The second analysis was to test the clinical impression that the fasting glucose level was the best predictor of insulin requirement in women with gestational diabetes. The results of the study showed that none of the 3 readings of the oral glucose tolerance test could be used to predict reliably which patients did not need insulin therapy. Hence, blood sugar profile assessment of all patients with gestational diabetes is still necessary. The receiver-operator characteristic curves also showed that the 2-hour postload glucose level during the 75 g load glucose tolerance test was a better predictor of insulin requirement than the fasting glucose level.

Management of diabetes mellitus in pregnancy.

Diabetes is a common problem in pregnancy and the incidence depends on the racial predisposition and geographical distribution where the reports originate. Despite improvement in perinatal care, many serious clinical problems are still associated with diabetes during pregnancy. The overall strategy of management includes early identification of diabetes during pregnancy, combined management to achieve optimal glucose control with dietary manipulation and insulin, maternal and fetal monitoring during the antenatal period and determination of the delivery time. Intensive intrapartum monitoring and neonatal care at delivery and thereafter are also essential. The outlook for the newborn of the diabetic mother has changed dramatically in recent years and both perinatal mortality and morbidity rate have declined as a result of pre-pregnancy preparation and meticulous control of maternal blood glucose throughout pregnancy. Successful pregnancy outcome depends on the cooperation of the patient, the obstetrician, the physician, the neonatologist and the health educator.

The management of hypertension in pregnancy.

Hypertension in pregnancy is a common and sometimes serious complication of pregnancy. It is a major cause of preventable perinatal and maternal mortality and morbidity. The principles of management include the recognition of risk factors, early diagnosis, close maternal and fetal monitoring with prompt identification and treatment of complications, the use of anti-hypertensive and anti-convulsant drugs when indicated and the timely delivery of the baby. In order to achieve the optimal pregnancy outcome, a joint approach between the physician, obstetrician and neonatologist is of great importance.