Karen L Lindsay1, Lorraine Brennan2, Maria A Kennelly1, Sinéad Curran3, Mary Coffey4, Thomas P Smith5, Michael E Foley1, Mensud Hatunic6, Fionnuala M McAuliffe7,8. 1. UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland. 2. UCD Institute of Food and Health, School of Food Science and Veterinary Medicine, University College Dublin, Dublin 4, Ireland. 3. Department of Clinical Nutrition, National Maternity Hospital, Holles Street, Dublin 2, Ireland. 4. Department of Midwifery, National Maternity Hospital, Holles Street, Dublin 2, Ireland. 5. Department of Clinical Chemistry, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. 6. Department of Endocrinology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. 7. UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland. fionnuala.mcauliffe@ucd.ie. 8. UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. fionnuala.mcauliffe@ucd.ie.
Abstract
BACKGROUND: Dietary advice is a standard component of treatment for pregnant women with impaired glucose tolerance (IGT) and gestational diabetes (GDM), yet few studies report glycemic profiles in response to dietary therapies and the optimal dietary approach remains uncertain. AIM: To assess changes in maternal glycemic profile and pregnancy outcomes among women with diet-controlled IGT and GDM. METHODS: Pregnant women who had one or more elevated values on a 3-h oral glucose tolerance test were enrolled. All participants received dietary advice and glucose monitoring as part of routine clinical care. Fasting and 1-h post-prandial blood samples, collected prior to initiation of clinical treatment and repeated 4-6 weeks later, were analyzed for glucose, insulin, and C-peptide. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Women who required pharmacological therapy for glucose control were excluded from analyses. RESULTS: Participants (N = 93) were of moderately older age (mean 33 years), with a high rate of overweight/obesity (mean body mass index (BMI) = 28.65 kg/m2), and were diagnosed late in gestation (mean 29 weeks). Fasting (mean ± SD 4.82 ± 0.53 to 4.60 ± 0.42 mmol/l; p < 0.001) and post-prandial glucose (7.01 ± 1.19 to 6.47 ± 1.10; p = 0.004) decreased significantly following the intervention. Baseline HOMA-IR was elevated (3.12 ± 1.03) but did not significantly decrease (2.78 ± 1.52; p = 0.066). There were high rates of macrosomia (24.7%) and cesarean delivery (32.3%). CONCLUSIONS: Although improvements in blood glucose levels were observed among women with diet-controlled IGT and GDM, this was insufficient to significantly affect insulin resistance or perinatal outcome. Late diagnosis and treatment of IGT/GDM may have contributed to such outcomes.
BACKGROUND: Dietary advice is a standard component of treatment for pregnant women with impaired glucose tolerance (IGT) and gestational diabetes (GDM), yet few studies report glycemic profiles in response to dietary therapies and the optimal dietary approach remains uncertain. AIM: To assess changes in maternal glycemic profile and pregnancy outcomes among women with diet-controlled IGT and GDM. METHODS: Pregnant women who had one or more elevated values on a 3-h oral glucose tolerance test were enrolled. All participants received dietary advice and glucose monitoring as part of routine clinical care. Fasting and 1-h post-prandial blood samples, collected prior to initiation of clinical treatment and repeated 4-6 weeks later, were analyzed for glucose, insulin, and C-peptide. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Women who required pharmacological therapy for glucose control were excluded from analyses. RESULTS:Participants (N = 93) were of moderately older age (mean 33 years), with a high rate of overweight/obesity (mean body mass index (BMI) = 28.65 kg/m2), and were diagnosed late in gestation (mean 29 weeks). Fasting (mean ± SD 4.82 ± 0.53 to 4.60 ± 0.42 mmol/l; p < 0.001) and post-prandial glucose (7.01 ± 1.19 to 6.47 ± 1.10; p = 0.004) decreased significantly following the intervention. Baseline HOMA-IR was elevated (3.12 ± 1.03) but did not significantly decrease (2.78 ± 1.52; p = 0.066). There were high rates of macrosomia (24.7%) and cesarean delivery (32.3%). CONCLUSIONS: Although improvements in blood glucose levels were observed among women with diet-controlled IGT and GDM, this was insufficient to significantly affect insulin resistance or perinatal outcome. Late diagnosis and treatment of IGT/GDM may have contributed to such outcomes.
Authors: Caroline A Crowther; Janet E Hiller; John R Moss; Andrew J McPhee; William S Jeffries; Jeffrey S Robinson Journal: N Engl J Med Date: 2005-06-12 Impact factor: 91.245
Authors: Mark B Landon; Catherine Y Spong; Elizabeth Thom; Marshall W Carpenter; Susan M Ramin; Brian Casey; Ronald J Wapner; Michael W Varner; Dwight J Rouse; John M Thorp; Anthony Sciscione; Patrick Catalano; Margaret Harper; George Saade; Kristine Y Lain; Yoram Sorokin; Alan M Peaceman; Jorge E Tolosa; Garland B Anderson Journal: N Engl J Med Date: 2009-10-01 Impact factor: 91.245