Is gestational diabetes a clinical entity?

Beard, R. W.; Hoet, J. J.

doi:10.1007/bf00253735

Cited by 37 publications

(10 citation statements)

References 30 publications

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“…Firstly, there may very well be a difference in the disorder between different populations with different genetic, nutritional and environmental backgrounds in different countries, and there have been no useful comparisons between such populations using standard criteria [58]. Secondly, there is a legitimate difference in outlook between the obstetrician who tends to adopt an interventionist policy in the belief that the fetuses of mothers with this condition are at risk of dying in utero [78], and the epidemiologist who reflects that the condition might almost be abolished if the diagnostic criteria were reset at a slightly higher level [79].…”

Section: Gestational Diabetesmentioning

confidence: 99%

Diabetes in pregnancy 1985

Hadden

1986

Diabetologia

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The art of obstetrics is not a subject which is often discussed in the pages of Diabetologia. However, as the care of the diabetic mother and her offspring is rightly an interdisciplinary responsibility between obstetrician, diabetologist and neonatologist, it is important that each has a close understanding of the various problems. Dr. M. I. Drury (Dublin), speaking as an internist, raises a question on the optimum time and method of delivery of the baby; this has more than purely obstetrical implications. Drs. L. Molsted-Pedersen (Copenhagen) and C. K~ihl (Copenhagen and Klampenborg), obstetrician and internist from the longest-established joint obstetric/diabetic service in the world, present a Scandinavian view on the management of pregnancy. Both centres have distinguished records in the management of diabetic pregnancy. The different viewpoints in Denmark and in Ireland are clear -in Copenhagen, therapeutic abortion is practiced in a pregnancy at risk of severe congenital malformation; in Dublin it is not. Dr. Drury quotes a perinatal loss of 13 of 285 pregnancies (4.5%) in the past 5 years, but does not include the recognised spontaneous abortions which, on his overall figures, are about 10% of conceptions. Dr. Molsted-Pedersen reports a perinatal loss of 3 of 201 infants (1.5%), excluding 17 spontaneous and 9 induced abortions. If these 9 aborted pregnancies, which were performed due to a risk of severe congenital malformation, were included as fatalities, the Copenhagen figure would be 12 of 210 (5.5%). Of course, we do not know if all those 9 fetuses were affected. The spontaneous abortion rate was 17 of 223 (8.0%). Thus, if total fetal loss is taken as the index, there appears to be little difference between the two centres. The clinical controversy on the timing and method of birth in the different centres will continue --pundits can be conservative as well as radical, and, as Dr. Drury remarks, the truth probably lies somewhere in between.The bottom line in reports on the management of diabetes in pregnancy used to be the perinatal mortality (from 28 weeks gestation to the end of the first week of life). With the continuing improvement in neonatal care, more babies who would have died during the perinatal period are surviving beyond the seventh day of life. As a result, their subsequent deaths are not recorded in many publications. Even greater emphasis will fall on the quality of life for those infants surviving with a major congenital abnormality (heart and neural tube defect) which produces profound childhood morbidity. Prevention of these congenital abnormalities is the most important aim of pre-and early conceptional care of the diabetic mother. Both centres which report their recent results in this issue would agree that there has been an improvement even in the past 5 years -the problem is to define exactly which developments account for the change for the better, and which previously-trusted techniques can safely be allowed to fall by the wayside.

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Section: Gestational Diabetesmentioning

confidence: 99%

Diabetes in pregnancy 1985

Hadden

1986

Diabetologia

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“…Because inappropriate hyperglycemia in GDM is mild, the mother presents with only weak symptoms, if any, whereas the offspring faces a four-to fivefold rate of perinatal mortality (4)(5)(6) and an increased morbidity (7). The latter includes neonatal hypoglycemia (8)(9)(10)(11), macrosomia (7)(8)(9)11), hyperbilirubinemia (7,9,11), hypocalcemia (7,11), as well as the respiratory distress syndrome and birth trauma (7). The overall fetal morbidity is as high as 25% (9,12), and, according to several reports, the hazards to the fetus appear to be of similar severity regardless of whether the mother has mild or pronounced GDM (7,13,14).…”

mentioning

confidence: 99%

“…CDM encompasses a heterogeneous array of disorders of insulin secretion and action whose hallmark is postprandial hyperglycemia (3). Because inappropriate hyperglycemia in GDM is mild, the mother presents with only weak symptoms, if any, whereas the offspring faces a four-to fivefold rate of perinatal mortality (4)(5)(6) and an increased morbidity (7). The latter includes neonatal hypoglycemia (8)(9)(10)(11), macrosomia (7)(8)(9)11), hyperbilirubinemia (7,9,11), hypocalcemia (7,11), as well as the respiratory distress syndrome and birth trauma (7).…”

mentioning

confidence: 99%

Prevention of Perinatal Morbidity by Tight Metabolic Control in Gestational Diabetes Mellitus

et al. 1988

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In a prospective controlled trial, we studied the effect of tight metabolic control on the outcomes of 102 gestational diabetes mellitus (GDM) pregnancies compared with outcomes of 102 matched nondiabetic control pregnancies. Women with GDM were treated to achieve and maintain a blood glucose concentration of less than 130 mg/dl at 1 h after breakfast. Treatment consisted of a diet low in oligosaccharides and fat and, if necessary, once daily insulin. By the end of gestation, 88 of the 102 women with GDM received insulin at a mean dose of 18 U/day. Duration of insulin therapy ranged from 3 to 32 wk with a median of 11 wk. Perinatal outcome of GDM pregnancies under this management equaled that of control pregnancies. The full spectrum of excess morbidity from GDM was prevented, and normal distribution of birth weight and normal rates of macrosomia, dystrophy, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal acidosis, and low Apgar scores were achieved. No mortality was observed. In addition to the two main study groups, we also studied a third group of 24 women with GDM whose treatment lasted less than or equal to 5 wk due to late diagnosis. This suboptimally treated group demonstrated a significant (P less than .05) increase of macrosomia and umbilical artery acidosis compared with the well-treated GDM group. The study reported herein demonstrates that excess mortality and morbidity typically observed in GDM can be prevented by early institution of tight metabolic control, which required insulin in 86% of our patients.

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“…Also it may be effective by normalizing the environment for the developing foetus, reducing other factors of neonatal morbidity (Beard & Hoet 1982). But for these statements further investigations need to be done.…”

Section: Discussionmentioning

confidence: 98%

The importance of insulin administration in gestational diabetics

Zoupas

Mastrantonakis

Diakakis

et al. 1984

Acta Endocrinologica

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Gestational diabetes is defined as a disturbed carbohydrate metabolism present during pregnancy but reverting to normal after delivery. It constitutes a current social problem since it may occur in 2 -3% of pregnancies and the incidence may be much greater in selected populations (Freinkel & Josimovich 1980). The known impact of this condition on perinatal mortality, foetal macrosomia and neonatal hypoglycaemia have dictated the need for an increased awareness, improved identification and special therapeutic management. Since the best therapeutic management of women with gestational diabetes,has not yet been established, we decided to investigate the following groups of pregnant women on the basis of upper normal limits of fasting blood sugar (FBS) 105 mg% (Metzger et al. 1981). Therefore the aim of the present study was to evaluate the effect and the value of insulin administration, once or twice daily, in patients with gestational diabetes. Subjects and MethodsA total of 103 pregnant women participated in the present study. In all women the diagnosis of gestational diabetes was made between the 24th and 32nd week of pregnancy, using the criteria of O'Sullivan & Mahan (1964). In ad¬ dition we attempted to graduate the severity of the disorder on the basis of the upper normal values for fasting plasma glucose. More speci¬ fically we investigated 35 women, with GD and FBS<105 mg% who were treated only by Diet (Group A), 21 women, with GD and FBS>105 mg% treated only by Diet (Group B) and 47 women, with GD and FBS>105 mg%, treated

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Is gestational diabetes a clinical entity?

Cited by 37 publications

References 30 publications

Diabetes in pregnancy 1985

Diabetes in pregnancy 1985

Prevention of Perinatal Morbidity by Tight Metabolic Control in Gestational Diabetes Mellitus

The importance of insulin administration in gestational diabetics

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