Julia Lowe

Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations with Neonatal Anthropometrics

OBJECTIVE—To examine associations of neonatal adiposity with maternal glucose levels and cord serum C-peptide in a multicenter multinational study, the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study, thereby assessing the Pederson hypothesis linking maternal glycemia and fetal hyperinsulinemia to neonatal adiposity. RESEARCH DESIGN AND METHODS—Eligible pregnant women underwent a standard 75-g oral glucose tolerance test between 24 and 32 weeks gestation (as close to 28 weeks as possible). Neonatal anthropometrics and cord serum C-peptide were measured. Associations of maternal glucose and cord serum C-peptide with neonatal adiposity (sum of skin folds >90th percentile or percent body fat >90th percentile) were assessed using multiple logistic regression analyses, with adjustment for potential confounders, including maternal age, parity, BMI, mean arterial pressure, height, gestational age at delivery, and the babys sex. RESULTS—Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, cord serum C-peptide results were available for 19,885 babies and skin fold measurements for 19,389. For measures of neonatal adiposity, there were strong statistically significant gradients across increasing levels of maternal glucose and cord serum C-peptide, which persisted after adjustment for potential confounders. In fully adjusted continuous variable models, odds ratios ranged from 1.35 to 1.44 for the two measures of adiposity for fasting, 1-h, and 2-h plasma glucose higher by 1 SD. CONCLUSIONS—These findings confirm the link between maternal glucose and neonatal adiposity and suggest that the relationship is mediated by fetal insulin production and that the Pedersen hypothesis describes a basic biological relationship influencing fetal growth.

Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations of maternal A1C and glucose with pregnancy outcomes

OBJECTIVE To compare associations of maternal glucose and A1C with adverse outcomes in the multinational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and determine, based on those comparisons, if A1C measurement can provide an alternative to an oral glucose tolerance test (OGTT) in pregnant women. RESEARCH DESIGN AND METHODS Eligible pregnant women underwent a 75-g OGTT at 24–32 weeks’ gestation. A sample for A1C was also collected. Neonatal anthropometrics and cord serum C-peptide were measured. Associations with outcomes were assessed using multiple logistic regression with adjustment for potential confounders. RESULTS Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, 21,064 had a nonvariant A1C result. The mean ± SD A1C was 4.79 ± 0.40%. Associations were significantly stronger with glucose measures than with A1C for birth weight, sum of skinfolds, and percent body fat >90th percentile and for fasting and 1-h glucose for cord C-peptide (all P < 0.01). For example, in fully adjusted models, odds ratios (ORs) for birth weight >90th percentile for each measure higher by 1 SD were 1.39, 1.45, and 1.38, respectively, for fasting, 1-, and 2-h plasma glucose and 1.15 for A1C. ORs for cord C-peptide >90th percentile were 1.56, 1.45, and 1.35 for glucose, respectively, and 1.32 for A1C. ORs were similar for glucose and A1C for primary cesarean section, preeclampsia, and preterm delivery. CONCLUSIONS On the basis of associations with adverse outcomes, these findings suggest that A1C measurement is not a useful alternative to an OGTT in pregnant women.

Preeclampsia as a Risk Factor for Diabetes: A Population- Based Cohort Study

Denice Feig and colleagues assess the association between gestational diabetes, gestational hypertension, and preeclampsia and the development of future diabetes in a database analysis of pregnant women in Ontario, Canada.

Missed opportunities for type 2 diabetes testing following gestational diabetes: a population-based cohort study

Please cite this paper as: Shah B, Lipscombe L, Feig D, Lowe J. Missed opportunities for type 2 diabetes testing following gestational diabetes: a population‐based cohort study. BJOG 2011;118:1484–1490.

Perceived risk of Type 2 diabetes in Australian women with a recent history of gestational diabetes mellitus

Diabet. Med. 27, 882–886 (2010)

Postnatal testing for diabetes in Australian women following gestational diabetes mellitus

Background:  Postnatal blood glucose testing is recommended for reclassification of glucose tolerance following a pregnancy affected by gestational diabetes mellitus (GDM); however, there are limited data on the postnatal follow‐up sought by Australian women.

Adverse reactions to frusemide in hospital inpatients.

Out of 2580 medical inpatients included in a drug-surveillance programme, 585 (22.7%) were treated with frusemide. Of these, 123 (21.0%) had a total of 177 adverse reactions. The most common were hypovolaemia (85 cases), hyperuricaemia (54), and hypokalaemia (21). Most reactions were mild, and only three patients had potentially life-threatening effects. The incidence of adverse reactions increased significantly with daily dose, occurring in 47 patients (13.5%) given up to 40 mg, 42 (26.3%) given up to 80 mg, and 34 (43.6%) given over 80 mg (P less than 0.001). There was no clear association between side effects and a raised blood urea concentration on admission, confirming that treatment with frusemide is not more hazardous in patients with renal failure. Frusemide is a safe and highly effective diuretic. Nevertheless, in view of the potential seriousness of volume depletion, dosage should probably begin at 20 rather than 40 mg daily.

Australian women's experiences of living with gestational diabetes

PURPOSE The purpose of this study was to describe Australian womens reflections on the experience of having a pregnancy affected by GDM. METHODS Participants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes. RESULTS Of 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve ones health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p=0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p=0.061). Those diagnosed with GDM in a previous pregnancy (p=0.034) and younger women (p=0.054) were less likely to view the diagnosis as an opportunity to improve their health. CONCLUSIONS This study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.

Evaluation of a diabetes education program in Newcastle, NSW

OBJECTIVE To assess the level of coverage and effectiveness of diabetes education provided by the Newcastle Diabetes Education and Stabilisation Centre (DESC) to people taking insulin. RESEARCH DESIGN AND METHODS A community based survey of people presenting a prescription for insulin to retail pharmacies in the Hunter Region. The study characterised participants and non-participants in the DESC program by social and demographic factors and assessed the knowledge, blood glucose control and symptoms of diabetic complications they reported. The study also assessed their attitude towards diabetes and diabetic self-care and their feelings towards and use of clinical services. RESULTS There were 229 respondents, 75% had attended the DESC course, however single males living in rural areas were significantly less likely to attend. Course attenders were more likely to do blood tests and visit an ophthalmologist and podiatrist than non-attenders, but were not more knowledgable about diabetes or reported fewer complications. Despite high levels of use of health care services including eye care, by people with diabetes, and an overall positive attitude to diabetes management, the study revealed a widespread ignorance of the serious consequences of diabetes. CONCLUSIONS People with diabetes taking insulin in the Hunter Region have an overall positive attitude to diabetes and a high level of participation in a formal diabetes education program. Attendance was associated with increased use of eye care and foot care services, despite little demonstrable effect on knowledge or self-reported diabetes control.

The Subjective Impact of a Diagnosis of Gestational Diabetes Among Ethnically Diverse Pregnant Women: A Qualitative Study

OBJECTIVE Women diagnosed with gestational diabetes mellitus (GDM) require enhanced medical care, social support and health behaviour changes to reduce the complications of pregnancy and future adverse health outcomes. Little is known about how a GDM diagnosis positively and negatively impacts women, especially those of diverse ethnic backgrounds. This qualitative study sought to gain insight into the reactions and experiences of multiethnic women diagnosed with GDM. METHODS A qualitative descriptive approach was used to analyze semistructured telephone interviews conducted with 19 pregnant women of diverse backgrounds who were diagnosed with GDM. Interviews were recorded and transcribed and then coded and analyzed using content analysis. RESULTS This study identified 2 main themes and several subthemes. First, women reported many negative effects of a GDM diagnosis, including heightened pressure to fulfill multiple roles, financial impact, and a disconnect between diabetes-prevention recommendations and their cultural practices. Second, a GDM diagnosis also had positive effects on many women. Women indicated being motivated to make health behaviour changes after a GDM diagnosis and viewed it as a wake-up call to modify their lifestyles. CONCLUSIONS To help pregnant women with self-management of gestational diabetes, healthcare providers should pay greater attention to the adverse effects of GDM on women, including role expectations, cultural issues and financial barriers. Healthcare providers also need to focus on the positive effects and capitalize on womens motivation to make lifestyle changes to reduce their future risk for diabetes.