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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGestational diabetes mellitus (GDM) is a common medical complication of pregnancy, defined as \u201cany degree of glucose intolerance with onset or first recognition during pregnancy.\u201d The initial criteria for its diagnosis were established over 40 years ago and, with modifications, remain in use today. This article discusses new strategies for the detection and treatment of GDM.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHyperglycemia\/Hypoglycemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMaternal NutritionPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EGestational diabetes mellitus (GDM) is a common medical complication of pregnancy, defined as \u201cany degree of glucose intolerance with onset or first recognition during pregnancy.\u201d The initial criteria for its diagnosis were established over 40 years ago and, with modifications, remain in use today. The criteria were chosen to identify women who were at high risk for development of diabetes after pregnancy or were derived from criteria that were used for nonpregnant individuals and not necessarily to identify pregnancies with increased risk for adverse perinatal outcome [International Association of Diabetes and Pregnancy Study Groups Consensus Panel. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was conducted to clarify the risks of adverse outcomes that were associated with various degrees of maternal glucose intolerance that were less severe than that in overt diabetes mellitus. Participants in the HAPO Study included 25,505 pregnant women at 15 centers in nine countries who underwent 75-g oral glucose tolerance (OGTT) testing at 24 to 32 weeks of gestation. Subjects whose fasting plasma glucose results were \u0026gt;105 mg\/dL (5.8 mmol\/L) or whose 2-hour plasma glucose level \u0026gt;200 mg\/dL (11.1 mmol\/L) were unblinded. Results for all other subjects remained blinded. The primary study outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord blood serum C-peptide level above the 90th percentile. Of the 25,505 women who completed an OGTT, data for 23,316 were available for analyses (746 [2.9%] subjects were excluded because their data were unblinded, 1412 [5.5%] for missing or unusable data). Adjusted odds ratios were calculated for adverse pregnancy outcomes that were associated with an increase of 1 standard deviation (SD) in the fasting plasma glucose level and the 1- and 2-hour glucose levels (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11542\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11542\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11542\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EOdds Ratios (95% CI) for Adverse Pregnancy Outcomes for 1 SD Change In Glucose Level.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EThe results of the HAPO study indicated strong, continuous associations of maternal glucose levels below those that are normally noted for a diagnosis of diabetes with increased birth weight and increased cord blood serum C-peptide levels [HAPO Study Cooperative Research Group\u003Cem\u003E. Intl J Gynaecol Obstet\u003C\/em\u003E 2002; \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2008; \u003Cem\u003EDiabetes\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ERecently, the International Association of Diabetes in Pregnancy Study Groups (IADPSG) Consensus Panel suggested new diagnostic criteria for the diagnosis and classification of GDM (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E) [International Association of Diabetes and Pregnancy Study Groups Consensus Panel. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. Because of the extensive efforts that were used to standardize procedures for participant enrollment, laboratory analyses, data collection, and the methods that were used to analyze the results, HAPO data were used as the basis for the new GDM diagnostic thresholds. The following is a summary of two presentations that examined the effects of those changes on the diagnosis of GDM.\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11547\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11547\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11547\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EScreening and Diagnosis of Hyperglycemia in Pregnancy.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EDavid R. Hadden, MD, Royal Victoria Hospital, Belfast, United Kingdom, presented the results of a study that showed that when the new IADPSG diagnostic criteria are used, there is substantial variability between and within regions (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E). There was also considerable center-to-center variation of study participants in maternal age, body mass index, frequencies of family history of diabetes, and hypertension. Adjusting for these variables and for field center reduced but did not eliminate center-to-center differences, which, in all likelihood, reflect racial\/ethnic group differences in the potential risk of disorders of glucose metabolism in these populations.\u003C\/p\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11548\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11548\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11548\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EUnadjusted Frequency of GDM at HAPO Field Centers.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EThe substantial variations may influence future efforts to develop optimal, cost-effective strategies for the detection and treatment of GDM, noted Prof. Hadden.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAnnunziata Lapolla, MD, University of Padova, Padova, Italy, presented the results of a study that evaluated the clinical and metabolic characteristics, and pregnancy outcome in women previously classified as normal by Carpenter and Coustan criteria [Carpenter MW \u0026amp; Coustan DR. \u003Cem\u003EAm J Obstet Gynecol\u003C\/em\u003E 1982] and now classified as having GDM utilizing the new IADPSG criteria.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EResults of this retrospective analysis of 3953 pregnancies indicated an increase in the diagnosis of GDM of approximately 20% (n=112) with the new criteria (\u003Ca id=\u0022xref-table-wrap-4-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T4\u0022\u003ETable 4\u003C\/a\u003E). Women who were diagnosed only under the new criteria were younger (32.4 \u00b1 4.5 years vs 33.4 \u00b1 4.4 years; p\u0026lt;0.005) and had a lower prepregnancy body mass index (23.7 \u00b1 4.3 kg\/m\u003Csup\u003E2\u003C\/sup\u003E vs 24.7 \u00b1 5.1 kg\/m\u003Csup\u003E2\u003C\/sup\u003E; p\u0026lt;0.005) than women who were diagnosed only under the older criteria. HbA1C levels at diagnosis and at the 3rd trimester were not different. Glucose levels on the OGTT were significantly higher in newly diagnosed women compared with those women with normal glucose tolerance on fasting (90.5 \u00b1 7.8 mg\/dL vs 79.2 \u00b1 6.8 mg\/dL; p\u0026lt;0.0001) and at 1 (153.7 \u00b1 18.8 mg\/dL vs 140.6 \u00b1 23.7; p\u0026lt;0.0001) and 2 hours (129.3 \u00b1 20.6 vs 116.3 mg\/dL \u00b1 20; p\u0026lt;0.0001).\u003C\/p\u003E\u003Cdiv id=\u0022T4\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11554\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11554\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11554\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 4.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EImpact of the New Diagnostic Criteria.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003ECesarean section was significantly (p\u0026lt;0.005) more common among women who were newly diagnosed (43.6%) and previously diagnosed (41%) with T2DM compared with women with normal glucose tolerance (31.1%). Gestational age at delivery and birth weight were not different. Ponderal index (g\/cm\u003Csup\u003E3\u003C\/sup\u003E) was significantly higher in previously diagnosed and newly diagnosed women versus those with normal glucose tolerance (2.95 \u00b1 0.61 mg\/dL vs 2.8 \u00b1 0.41 mg\/dL and vs 2.77 \u00b1 0.34 mg\/dL; p\u0026lt;0.0001, respectively). A correlation analysis showed that prepregnancy BMI and basal glucose level were significantly related with newborn ponderal index (p\u0026lt;0.0001 and p\u0026lt;0.05, respectively).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EThe new GDM diagnostic criteria that have been recommended by IADPSG identified a new group of women who were previously classified as normal with Carpenter and Coustan criteria. These women have metabolic characteristics and pregnancy outcomes that are similar to those of women who are diagnosed under the older criteria.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/9\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmo4d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmo4d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}