Helena Fadl

Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003.

Diabet. Med. 27, 436–441 (2010)

Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study.

To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high‐risk groups.

Fasting capillary glucose as a screening test for gestational diabetes mellitus

Objective  To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.

Intervention during pregnancy to reduce excessive gestational weight gain—a randomised controlled trial

To evaluate if a feasible, low‐cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care.

Perinatal outcome in relation to fetal sex in offspring to mothers with pre‐gestational and gestational diabetes—a population‐based study

The objective of the present study was to investigate if perinatal outcome differs with fetal sex in pregnancies with maternal Type 1 diabetes, Type 2 diabetes or gestational diabetes.

Disproportionate Body Composition and Neonatal Outcome in Offspring of Mothers With and Without Gestational Diabetes Mellitus

OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm3) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA.

Outcomes of gestational diabetes in Sweden depending on country of birth

Objective. To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non‐Nordic women). Design. Population‐based cohort study using the Swedish Medical Birth register. Setting. Data on pregnant women in Sweden with diagnosed GDM. Population. All singleton births to women with GDM between 1998 and 2007 (n = 8560). Methods. Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi‐squared tests or Students unpaired t‐tests were used to analyze differences between maternal and fetal characteristics. Main outcome measures. Maternal and neonatal complications. Results. GDM incidence was higher at 2.0% among non‐Nordic women, compared with 0.7% in the Nordic group. The non‐Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non‐Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large‐for‐gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non‐Nordic group. Large‐for‐gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5–0.7) and adjusted odds ratio 0.8 (0.6–0.9)]. Conclusions. Non‐Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large‐for‐gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.

Trends in diabetes in pregnancy in Sweden 1998–2012

Objective Diabetes in pregnancy has been shown to increase in parallel with the increasing prevalence of obesity. In this national population-based study, we analyzed the trends for gestational diabetes mellitus (GDM), type 1 diabetes in pregnancy, and type 2 diabetes in pregnancy in Sweden between 1998 and 2012. Research design and methods A population-based cohort study using the Swedish national medical birth registry data. The time periods were categorized into 3-year intervals and adjusted for maternal body mass index (BMI), ethnicity, and age in a logistic regression. Results Each type of diabetes increased over the studied 15-year period. Type 1 diabetes increased by 33.2% (22.2–45.3) and type 2 diabetes by 111% (62.2–174.4) in the adjusted model. Nordic women had the highest prevalence of type 1 diabetes (0·47%) compared with other ethnic groups. The increase in GDM and, to a lesser extent, type 2 diabetes was explained by country of birth, BMI, and maternal age. The prevalence of GDM in Nordic women (0.7–0.8%) did not increase significantly over the time period. Conclusions All types of diabetes in pregnancy increased over the 15-year time period in Sweden. Maternal pre-pregnancy BMI remains the key factor explaining the increase in GDM/type 2 diabetes. How to turn around the growing prevalence of diabetes in pregnancy, with its short-term and long-term health effects on both mother and child, requires population-based interventions that reduce the likelihood of entering pregnancy with a raised BMI.

Overweight and obesity : a remaining problem in women treated for severe gestational diabetes

To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes.

Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes.

A randomized multicenter study was conducted in the Stockholm‐Örebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.