We show that in the already high-risk settings of both GDM and PGDM, excessive GWG confers an additive risk for LGA birth weight, macrosomia, and gestational hypertension.

The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks (n = 307) were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at prepregnancy care was associated with receiving adequate screening (odds ratio 6.23; CI 3.39–11.46 (P < 0.001)). Among those who received adequate evaluations (n = 185), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.01–1.06, P = 0.02) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.09–3.87, P = 0.03) significantly increased the odds of progression. A significant proportion of women continue to demonstrate retinopathy progression during pregnancy. This study highlights the role of prepregnancy care and the importance of close monitoring during pregnancy and identifies those patients at the highest risk for retinopathy progression.

Investigating the pharmacoeconomic impact of any diagnostic or therapeutic intervention in the Irish healthcare setting is currently compromised by the lack of detailed cost data. Consequently, we conducted a number of microcosting studies in the areas of acute myocardial infarction, cardiac failure and HIV, from the hospital perspective. The results of these microcosting studies were compared with the costing estimates assigned to hospital admissions, based on the diagnosis-related group system. Differences ranged from 9 to 66%. It was concluded that the diagnosis related group system is a useful estimate of costs for patient admissions in the absence of detailed cost of illness data. However, supplementary costing studies should be performed for certain therapeutic areas, particularly those where investigation and/or treatment costs are high.

Background and aims-We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding. Subjects-Participants in randomized controlled trial comparing DSRS to TIPS.Methods-Quality of life (QOL) measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using Data Treeage ®. Costs for both in-and outpatient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years.Results-The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492 respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost-effectiveness of TIPS increased slightly.Conclusions-TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures.