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Search Results: 1 - 10 of 8381 matches for " Gestational Diabetes "
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Long Lasting Effects of Breastfeeding on Metabolism in Women with Prior Gestational Diabetes  [PDF]
Luca Mattei, Antonietta Colatrella, Olimpia Bitterman, Paola Bianchi, Chiara Giuliani, Giona Roma, Camilla Festa, Gianluca Merola, Vincenzo Toscano, Angela Napoli
Journal of Diabetes Mellitus (JDM) , 2014, DOI: 10.4236/jdm.2014.44037
Abstract: Background & Aims: Breastfeeding improves glucose tolerance in the early postpartum period of women with prior gestational diabetes GDM, but it is unclear whether future risk of metabolic alterations, like type 2 diabetes, is reduced. The aim of this study was to investigate the effect of lactation, three years after pregnancy, on glucose and lipid metabolism in women with prior gestational diabetes. Materials & Methods: A population of women with prior gestational diabetes (Carpenter and Coustan Criteria) was evaluated with comparison of results for “lactating” [BF] versus “nonlactating women” [non BF]. Breast feeding was defined [BF] if lasting? 4 weeks. In each woman a 75-g oral glucose tolerance test (OGTT) was performed to analyze the glucose tolerance, insulin sensitivity/resistance and b-cell function. Fasting serum was used to study their lipid profile (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides), apolipoprotein B, apolipoprotein A1, homocysteine, fibrinogen, hsCRP, uric acid, microalbuminuria. Statistics: Paired and Un-paired t-test, Mann-Whitney and χ2 tests were used, as appropriate. Results: A total of 81 women were evaluated (62 [BF] and 19 [non BF]). Maternal age (37.1 ± 4.6 vs 37.4 ± 4.9 years), body mass index (26.3 ±
Medical Management of Gestational Diabetes  [PDF]
Ayesha Anwar, Kashif Ahmad, Evdokia Karagianni, Stephen Lindow
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.84045
Abstract: Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is on the rise due to increasing trends of obesity in females of child bearing age as well as due to increasing maternal age. Women at higher risk should be routinely screened of the condition and offered appropriate management in order to avoid fetal and maternal complications. GDM is associated with higher incidence of maternal and fetal complications during pregnancy and labour. There is a significant relationship between GDM and prediabetic states as well as high risk of developing type 2 diabetes mellitus. The aim of management is to keep glycaemic levels within specific targets to avoid adverse outcomes. Improved health related quality of life has been linked with treatment of gestational diabetes with active lifestyle, glucose monitoring and use of insulin. Historically, non pharmacological intervention and insulin have been the main approaches in management of GDM, though recently there is an emerging evidence of use of oral hypoglycemic agents. In this article
The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review  [PDF]
Jephthah O. Odiba, Mzwandile A. Mabhala
Journal of Diabetes Mellitus (JDM) , 2015, DOI: 10.4236/jdm.2015.52007
Abstract: Background: Insulin therapy has been the mainstay in managing women with gestational diabetes mellitus (GDM), but some disadvantages of insulin have led to the use of glyburide, which is inexpensive in some countries, to manage GDM. However, there has been debate over its effectiveness, efficacy and safety when compared to insulin for maternal glycaemic control, and some adverse neonatal outcomes in GDM. Method: A systematic review of eight randomised controlled trial (RCT) studies was undertaken to compare glyburide and insulin. Studies involving 849 participants were included in the quantitative analysis. Results: There was no significant difference between glyburide and insulin in maternal fasting (P = 0.09; SMD: 0.13; 95% CI: 0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: 0.09 to 0.19) glycaemic control and glycosylated hae-moglobin (P = 0.35; SMD: 0.08; 95% CI: 0.08 to 0.24). When compared with insulin, glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Estimation of standard mean difference shows that neonatal birth weight was significantly higher in subjects receiving glyburide than in the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclusions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. However, its adverse outcomes—neonatal hypogly-caemia, high neonatal birth weight and large for gestational age babies—call for careful monitoring of GDM patients for any need for supplemental insulin.
Maternal Plasma Lipid Profile in Women Screened for Gestational Diabetes Mellitus (GDM)  [PDF]
Adeniran Samuel Atiba, Babatunde Ajayi Olofinbiyi, Akindele Rasaq Akintunde, Aduloju Olusola Peter, Ojo Olubunmi Clementinah, Akinlua Ibikunle
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.712123
Abstract: Objective: This is to determine the plasma lipid profile status of patients diagnosed with gestational diabetes mellitus. Methodology: Seventy-nine pregnant women between gestational age of 24 and 28 weeks out of which 23 and 16 were diagnosed of having GDM using IADAPSG and WHO guidelines respectively were recruited into the study. Plasma lipid profile was determined among the study groups using standard laboratory techniques. Results: Higher numbers of women were diagnosed with GDM using IASDAPG criteria than when WHO criteria were used. Plasma lipid profile showed no significant difference between women with GDM and Non-GDM irrespective of guidelines used in the diagnosis of GDM. Conclusion: Pregnancy and Gestational Diabetes Mellitus may have influence on lipid metabolism but not likely in the second trimester of pregnancy as observed in our study.
Modifiable Risk Factors for Developing Diabetes Among Women With Previous Gestational Diabetes
Shumei Yun, MD, PhD,Nisreen H. Kabeer, MPH,Bao-Ping Zhu, MD, MS,Ross C. Brownson, PhD
Preventing Chronic Disease , 2007,
Abstract: IntroductionGestational diabetes mellitus (GDM) affects approximately 2% to 4% of all pregnant women in the United States each year. Women who have had GDM are at high risk for developing nongestational diabetes. The objective of this study was to assess the prevalence of modifiable risk factors for developing diabetes among women with previous GDM only.MethodsCross-sectional data for nonpregnant women from the 2003 Behavioral Risk Factor Surveillance System were used to estimate and compare the prevalence of modifiable risk factors among three groups: nonpregnant women with previous GDM only, nonpregnant women with current diabetes, and nonpregnant women without diabetes.ResultsIn 2003, 7.6% of nonpregnant women aged 18 years and older in the United States had current self-reported physician-diagnosed diabetes, and 1.5% had previous GDM only. Compared with women without diabetes, women with previous GDM only had higher prevalence of no leisure-time physical activity (32.0% vs 25.7%), overweight (62.2% vs 49.0%), and obesity (29.4% vs 20.0%). After adjusting for sociodemographic variables, women with previous GDM only were more likely to have no leisure-time physical activity (prevalence odds ratio [POR], 1.4; 95% confidence interval [CI], 1.2–1.7) and more likely to be overweight (POR, 1.8; 95% CI, 1.6–2.2) or obese (POR, 1.7; 95% CI, 1.4–2.1), compared with women with no diabetes. ConclusionWomen with previous GDM are more likely to have modifiable risk factors for developing diabetes than women without diabetes. More attention to this issue is needed from health care providers and public health officials to encourage the promotion of healthy lifestyles during and after pregnancy.
The effect of antenatal corticosteroids on maternal serum glucose in women with diabetes  [PDF]
Allison Kreiner, Karen Gil, Justin Lavin
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.22021
Abstract: Objective: To evaluate changes in serum glucose values following administration of corticosteroids in women with gestational (GDM) or pre-gestational diabetes (PGDM). Method: Patients with diagnoses of pregnancy and GDM or PGDM from 2006-2009 who received corticosteroids for enhancement of fetal pulmonary maturity as an inpatient were identified following IRB approval. Fasting (FSG) and two hour post prandial serum (PPSG) glucose levels, and oral anti-hyperglycemic agents and insulin given were recorded. Day 1 (D1) was the day the first dose of corticosteroid was administered. The percentage of women with FSG > 95 mg/dL and the percentage with at least one PPSG > 120 mg/dL during each day were calculated. Data were analyzed utilizing SPSS v15. Results: Fifty-five patients met the study criteria. FSG was greater than 95 mg/dL in over 90% of women on Days 2 and 3 and remained elevated in 51% on Day 4. At least one PPSG was greater than 120 mg/dL in 81% - 98% on Days 1 - 3, and in over 60% on Days 4 - 6. The majority of women taking insulin received increases in doses that were less than double their regular dose (26 out of 33); the others received higher doses. Three of 6 patients who began the study taking glyburide were started on insulin. Of the 19 who began the study with diet controlled GDM, 11 were started on medication. Conclusion: Women with GDM or PGDM who are administered antenatal corticosteroids will experience prolonged serum glucose levels above the range associated with optimal pregnancy outcome.
Nutritional Correlates of Women with a History of Gestational Diabetes and Insulin Resistance in the National Health and Nutrition Examination Survey (NHANES) 2000-2010  [PDF]
Dotun Ogunyemi, Amy Whitten, Arnold M. Mahesan, Anthea B. M. Paul, Judy Boura
Journal of Diabetes Mellitus (JDM) , 2016, DOI: 10.4236/jdm.2016.61008
Abstract: Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake, nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2000-2010. Data analysis was based on 290 women who reported a history of GDM compared to 4239 women who denied a GDM history. Insulin resistance [HOMA_IR = (fasting insulin in mU/mL × fasting glucose in mmol/L)/405] was calculated. Pearson correlation, Wilcoxon rank sum tests, Student’s t-tests, and chi-square analysis were used while linear regression assessed independent associations. Results: The median time-lapse from the diagnosis of GDM was 15 years. Women with a GDM history had significantly higher body mass index (BMI), other anthropometric measurements, diastolic blood pressures and insulin resistance. They were also more likely to be Hispanic, have delivered macrosomic infants, and delivered via cesarean. Previous GDM history compared to non-GDM subjects had significantly higher dietary intakes of energy calories, protein, total fat, saturated fatty acids, mono-saturated fatty acids, and cholesterol. Within the entire cohort, increasing insulin resistance was also associated with lower income, less college education, Hispanic or African American ethnicity, obesity, higher systolic and diastolic blood pressures, and with higher dietary cholesterol but lower intake of dietary fiber and micronutrients. Regression analyses showed that GDM history, Hispanic ethnicity, BMI, dietary intake of cholesterol and decreasing income were independently predictive of insulin resistance. Conclusion: The data confirm that even many years after a pregnancy associated with GDM, women with a history of GDM still report significantly higher dietary intakes of energy calories, protein, and fat with no corresponding increase in consumption of dietary fiber or minerals and vitamins. Consequently, the increased calorie and food consumption of women with previous GDM are associated with obesity, insulin resistance and higher blood pressures. These observations may suggest the need to target high-risk groups who may need more resources and awareness of the benefits of quality nutrition.
Vitamin D Deficiency and Gestational Diabetes Mellitus in Egyptian Women  [PDF]
Ghada M. El-Sagheer, Asmaa Kasem, Iglal M. Shawky, Ahmed Abdel-Fadeel
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2016, DOI: 10.4236/ojemd.2016.62015
Abstract: Background: Although recent meta-analyses indicates a consistent significant inverse relation of serum 25 (OH) D and the prevalence of gestational diabetes mellitus (GDM), the mechanism is unclear and conflicting opinions continue to be reported. Objectives: The objectives are: 1) comparison of vitamin D status in diabetic and non-diabetic pregnant women; 2) trying to determine the level of vitamin D associated with GDM, and its sensitivity and specificity; 3) determination of the relation of hypovitaminosis D with insulin resistance. Subjects and Methods: One hundred consecutive pregnant women (<28 weeks gestational period) from the attendants of the out-patient clinic at our hospital were diagnosed for GDM by glucose tolerance test (GTT) (75 g 2 h). Among them, 40 patients met the inclusion criteria for this study (group I). As a comparative group, another 40 pregnant ladies were included, 20 of them (group II) had pre-gestational type II DM, and the other 20 (group III) had normal glucose tolerance (NGT) as a control. For all the participants, we estimated fasting blood glucose, fasting serum insulin, homeostasis model assessment of (HOMA-IR and HOMA-B), quantitative insulin sensitivity check index (QUICKI), and serum 25-OH vit D. The ROC curve analysis was used to determine the optimal threshold value of vit D in relation to DM. Results: Compared to the control group, the diabetic patients showed a statistically significant increase in the levels of fasting glucose, 1-hour postprandial glucose, 2-hour post prandial glucose, fasting insulin, and HOMA-IR, (P=0.000 for all). None of the diabetic patients showed optimal vit D level. Vit D insuficiency (10 - 29 ng/ml) was found in 32.5% of patients in group I, 55% in group II, and 50% in group III. Vit D deficiency (<10 ng/ml) was found in 67.5% of patients in group I, 45% in group II, and 0% in group III. Significant negative correlation was found for vit D with fasting insulin and FBS. The AUC for 25 OH vit D was 97%, CI was 95% and p-value was 0.0001. The sensitivity, specificity, and positive and negative predictive values of 25 OH vit D in GDM versus control persons were 97%, 90%, 95.1%, 94.7% respectively at a cut-off level <22 ng/ml. Conclusions: Although it might seem premature to draw a sharp relation between hypovitaminosis D and GDM, this study showed the importance of vit D in GDM, the need for supplementation below 22 ng/ml, and the role of hypovitaminosis D in increasing insulin resistance. Further randomized studies with vit D supplementation are recommended.
Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus  [PDF]
Kalpana Tyagaraj, Alexandra Mazur, Agnes Miller, Dennis Feierman
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.610026
Abstract: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is considered to be a variant or severe form of pre-eclampsia, a life threatening complication of pregnancy. Gestational Diabetes Insipidus (GDI) can coexist with severe preeclampsia and HELLP syndrome. The combination of these two conditions presents a unique challenge to the anesthesiologist and the obstetric team, caring for this parturient. We present the case of a parturient with an unusual presentation of GDI, coexisting with severe preeclampsia and HELLP syndrome. She had two days history of polyuria and polydipsia as well as lethargy and rapidly rising serum sodium in addition to acute renal failure without any neurologic symptoms. Expeditious delivery of the baby and supportive management is essential for optimal outcomes. She underwent a repeat Cesarean section under combined spinal epidural (CSE) anesthesia. This patient was discharged on postoperative day five after clinical resolution of her signs and symptoms.
Progress in Research on Nonalcoholic Fatty Liver and Gestational Diabetes  [PDF]
Zehua Luo, Qingming Wu
International Journal of Clinical Medicine (IJCM) , 2019, DOI: 10.4236/ijcm.2019.104019
Abstract: Although there is ample evidence that non-alcoholic fatty liver disease (NAFLD) is associated with impaired glucose homeostasis in the body, the clinical significance of NAFLD in pregnant women has not been established. Current studies have shown that women with NAFLD during early pregnancy have a significantly increased incidence of gestational diabetes mellitus (GDM) during pregnancy; whereas women with a history of GDM have a significantly increased probability of developing NAFLD in the future. Both may be a manifestation of an etiology in both systems, reflecting the impaired glucose homeostasis and the continuity of insulin resistance. For women with NAFLD found in early pregnancy, it is recommended to closely monitor blood glucose during pregnancy, and if necessary, early intervention to strengthen prenatal and postnatal care. The presence of GDM at a young age in women may be an early marker that helps to screen out women at higher risk of developing a disease before significant metabolic disease, and is of great significance in reducing associated morbidity and mortality.
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