Maternal 25OHD concentrations are inversely related to fasting glucose, although further studies are required to establish whether this is independent of the effects of ethnic background.

Pre-GDM and GDM continue to be associated with an increased risk of adverse maternal and neonatal outcomes; however, women with GDM have adverse outcomes less frequently. Rates of GDM and pre-GDM appear to be increasing over time. Clinicians should consider the potential for adverse outcomes, and arrange referral to appropriate services.

Objective: Vasculitis is a rare complication of anti-thyroid medications. There are 32 cases of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis in association with anti-thyroid medication reported in the English literature. The objectives of this study were to assess the frequency of positive ANCA in patients on long-term anti-thyroid medication, and to follow patients prospectively from commencement of medication to determine whether they became ANCA-positive after therapy. Design: Prospectively collected cross-sectional study of two groups of patients: (i) who had received long-term (>18 months) anti-thyroid medication, and (ii) newly diagnosed thyrotoxicosis before commencement of anti-thyroid medication attending clinic between 28 April 1998 and 30 September 1998. Data were collected for age, sex, ethnicity, underlying thyroid disease, medication and duration, and symptomatology. Results: Eight of 30 patients on long-term anti-thyroid medication (26.7%) were ANCA-positive. All ANCA-positive patients were female, seven were taking propylthiouracil (PTU) at the time of testing. ANCA-positive patients had taken PTU for a mean Ϯ S.D. of 7.9 Ϯ 10.2 years, compared with 0.8 Ϯ 2.2 years in ANCA-negative patients (Mann-Whitney, P < 0.0001). The ten patients with newly diagnosed thyrotoxicosis were ANCA-negative before commencement of carbimazole. One (10%) became ANCApositive within 8 months of therapy. Conclusions: In our population, ANCA-positivity in association with long-term anti-thyroid medication is common (26.7%). One patient who was ANCA-negative prior to anti-thyroid therapy has become ANCA-positive. ANCA should be tested in patients receiving long-term anti-thyroid medications, and in patients with adverse reactions. As PTU is more commonly associated with vasculitis and positive ANCA, carbimazole may be the preferred medication for long-term use. Patients with positive ANCA should be followed, and considered for definitive anti-thyroid therapy, to allow cessation of medication. ANCA-positivity may resolve after cessation of anti-thyroid medication.

In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) panel published consensus-based recommendations on the diagnosis and classification of hyperglycemia in pregnancy (1). Within that document, the recommendations regarding early pregnancy testing were designed to facilitate early detection and treatment of hyperglycemia (HbA 1c $6.5% [48 mmol/mol], fasting venous plasma glucose $7.0 mmol/L, random plasma glucose $11.1 mmol/L with confirmation) that, outside pregnancy, would be classified as diabetes. The term "overt diabetes" was suggested to describe these women. Subsequently, the World Health Organization (WHO) adopted the IADPSG criteria with some modifications and promoted the use of the term "diabetes in pregnancy" (2) for this group.Cognizant that milder degrees of hyperglycemia would also be detected by early pregnancy testing, the IADPSG also recommended that fasting plasma glucose (FPG) in the range 5.1-6.9 mmol/L should be considered diagnostic of gestational diabetes mellitus (GDM) if noted at any time during pregnancy. More recent data from Italy (3) and China (4), where IADPSG diagnostic criteria were applied, have strongly challenged this recommendation, demonstrating a clear fall in FPG in early pregnancy and showing that early FPG $5.1 mmol/L is poorly predictive of later GDM at 24-28 weeks' gestation. Zhu et al. (4) suggested using FPG 6.1-6.9 mmol/L "at the time of booking and the first prenatal visit" as a pragmatic criterion for GDM diagnosis in China. To date, similar data have not been reported in other populations.We note that no randomized controlled trial data exist regarding the balance between additional benefits and costs of detecting and treating degrees of hyperglycemia less severe than "overt" diabetes from early pregnancy.The potential utility of HbA 1c in early pregnancy has also been addressed. In particular, a large cohort study from New Zealand (5) noted that HbA 1c $5.9% (41 mmol/mol) identified all cases of WHO diabetes in pregnancy and was associated with a twofold risk of congenital anomalies, preeclampsia, and shoulder dystocia and a threefold risk of perinatal deaths. The use of HbA 1c in this context is not currently endorsed by major national bodies and must carry some caveats because of the known limitations of the test. However, despite its poor sensitivity for impaired fasting glucose and impaired glucose tolerance, HbA 1c may offer a pragmatic means of identifying women at high risk of serious pregnancy complications and warrants further detailed evaluation.In conclusion, we suggest that the use of the IADPSG fasting glucose threshold of $5.1 mmol/L for the identification of GDM in early pregnancy is not justified by current evidence and that an early HbA 1c $5.9% (41 mmol/mol) may identify women at higher risk for adverse pregnancy outcomes. In contrast to "standard" GDM testing at 24-32 weeks' gestation, insufficient data exist to confidently recommend cutoff points for oral glucose tolerance testing in early pregnancy (e.g....

Prevalence of and risk factors for osteoporosis in a community population of 94 young adults with mental retardation was examined. Results show lower bone mineral density in this group than in an age-matched reference population. Factors associated with low bone mineral density included small body size, hypogonadism, and Down syndrome in both genders and a high phosphate level in females. Low vitamin D levels were common in both genders, despite high levels of exposure to sunshine. A history of fracture was also common. Low bone mineral density and fracture were associated in females but not males. Because morbidity following fracture is likely to be more serious in this population, further investigation of osteoporosis and prevention strategies for both osteoporosis and fractures are important.