Pregnancy outcome in women with gestational diabetes mellitus according to the Carpenter-Coustan criteria in Thailand.

AIM: To compare the pregnancy outcome of patients diagnosed with gestational diabetes mellitus (GDM) using the Carpenter-Coustan (CC) criteria with that of non-GDM pregnant women at Siriraj Hospital, Bangkok. METHODS: A retrospective study was carried out by reviewing medical records of pregnant women who underwent 100-g oral glucose tolerance test (OGTT) for diagnosing GDM between January 2009 and December 2012 at Siriraj Hospital. Pregnant women were divided into three groups according to the 100-g OGTT result: group 1, pregnant women with normal OGTT on both CC and National Diabetes Data Group (NDDG) criteria; group 2, pregnant women with normal OGTT on NDDG criteria but GDM on CC criteria; and group 3, pregnant women with GDM on CC criteria after December 2012 and enrolled in glycemic control program. Maternal and perinatal outcomes were compared between the groups. RESULTS: During the study period, the incidence of GDM increased 32.76% using the CC criteria. These women (group 2) had a higher risk of neonatal hypoglycemia (6.7% vs 0.6%; OR, 12.3; P < 0.0001), neonatal hyperbilirubinemia (13.7% vs 7.8%; OR, 1.9; P = 0.013) compared with group 1. Pregnant women in group 3 had a lower incidence of immediate post-partum hemorrhage from vaginal delivery than group 2 (0 vs 2.9%; P = 0.04) as well as lower rates of neonatal hypoglycemia and neonatal hyperbilirubinemia. CONCLUSION: Use of CC criteria increases the prevalence of GDM, but managing these women according to the program for GDM can improve the adverse neonatal outcome.

Clinical significance of atypical glandular cells in cervical Papanicolaou smears.

OBJECTIVE: To determine the prevalence and the rate of clinically significant lesions in women with atypical glandular cells in cervical Papanicolaou smears. MATERIAL AND METHOD: A retrospective study was performed from the cytologic database of Charoenkrung Pracharak Hospital. All cervical cytologic examinations with a diagnosis of atypical glandular cells (AGC) between January 2002 and December 2009 were identified. Medical records were reviewed to determine the clinical data. Cytologic and histologic follow-up was obtained to establish the presence of clinically significant lesions. RESULTS: One hundred eleven AGC Pap smears were identified from 47,347 Pap smears. The prevalence of AGC was 0.23% over the eight years of the period studied. Clinically significant lesions were diagnosed in 32.4% of the women, including invasive cancer in 18.3%. Women with AGC favor neoplasia were more likely to have clinically significant lesions (53.8%) than women with AGC not otherwise specified (20%, p = 0.003). The rate of clinically significant lesions in women aged 35 years or older (35.7%) was not statistically significant different from women younger than 35 years of age (20%, p = 0.356). All cases of invasive cancer were found in women aged 35 years or older Cervical adenocarcinoma was the most common invasive cancer found in the present study. CONCLUSION: Women with atypical glandular cells on Papanicolaou smears were correlated with significant risk for clinically significant lesions, including invasive cancer Initial evaluation should include colposcopy, directed biopsy, and endocervical curettage. Women with risk factors for endometrial cancer should have an endometrial sampling.

Incidence of large-for-gestational age newborn: a comparison between pregnant women with abnormal and normal screening test for gestational diabetes.

OBJECTIVE: To evaluate the incidence of large-for-gestational age (LGA) newborn between pregnant women with abnormal and normal glucose challenge test (GCT). DESIGN: Retrospective cohort study. MATERIAL AND METHOD: Two hundred and sixty pregnant women, who were at risk for gestational diabetes mellitus (GDM), received screening following practice guideline. The women were divided into two groups. The study group comprised of 130 women whose screening test results of 50-g 1-hour GCT were abnormal but had not been diagnosed with GDM (normal oral glucose tolerance test). The control group comprised of 130 women whose GCT results were normal. Comparison of various maternal and neonatal characteristics as well as the incidence of LGA between the groups was made. RESULTS: There were no significant differences in age, gestational age at first antenatal care, body mass index, and risk of GDM between the two groups. The study group had a significantly higher number of parity and number of risk factors of GDM than the control group. There was no significant difference in the incidence of LGA newborn between the two groups (8.5% in the study group and 10.8% in the control group, p = 0.528). There were also no significant differences in gestational age at delivery, pre-eclampsia, pre-term delivery, hyperbillirubinemia of the newborn between the two groups. There were no cases of maternal acute postpartum hemorrhage, and birth asphyxia. CONCLUSION: The incidence ofLGA newborn was similar between non-GDMwomen with abnormal and normal screening GCT results in Siriraj Hospital.